Going for Green: Driving pain and safety reassessment outcomes through electronic actionable feedback
Improve pain & opioid safety reassessment documentation through automated EMR audits. Technology provides continual feedback to RN & unit manager increases compliance. RN's had access to own weekly trends.Stoplight signal alerts RN to compliance by Green above 90%, Yellow 80-90%, Red below goal.
Relevance/Significance:
Pain reassessment increases pt satisfaction & sedation reassessment prevents opioid induced respiratory depression.Improving documentation of reassessment of pain and sedation failed despite readucation.Providing direct feedback w/automated audit identifies units w/inconsistent charting. Incorporating reassessment into workflow using automated feedback focuses on changing behavior and raises standards among RNs & unit leaders.Unbiased feedback by Pain Champions encouraged success among peers..
Strategy and Implementation:
Analgesic is charted,computer program scans EMR for pt-identifier; unit; RN signature; triggers next 4 hour for pain reassessment documentation(YES) if absent(NO).If analgesic is opioid it also triggers 90 min. scan for Sedation Assessment documentation (YES)/absent(NO).Percents extrapolated every Friday and by WED %YES vs. %NO tallied by unit and each RN. RN instructed to monitor pain w/in 4 hrs.,sedation at the peak effect of opioid. 90 min. gives RN room for clinical judgement. RNs attended a competency fair to lookup individual/unit/overall compliance. 90% compliance was highlighted by green dots,80-89% by yellow dots and red dots indicated noncompliance. The RNs could review by cross checking with EMR.Pain champions(PC)worked closely w/managers and staffed huddles,practice committee meetings & posted unit's weekly progress. Unit leaders applauded "Green Light" achievers.If no improvement in 3 months, Managers counselled RNs who consistently fell below 80% compliance.
Evaluation:
Going for GREEN changed culture. RNs paid closer attention to documentation practices. Peer involvenment supported practice changes. PC's focused on "new" ways to assure compliance. PC's worked with EMR programmers to initiate alerts when reassessments were due. Compliance doubled for pain,sedation reassessment.Decrease in opioid-induced respiratory depression naloxone rescues.
Implications for Practice:
Going fot green improves patient pain satisfaction and medication safety by providing RNs with access to timely, automated compliance data, through progressive self-improvement. Management and peer support drives the connection to quality, safety to improve patient outcomes.