Postoperative Pain Management: A Performance Improvement Project to Enhance the Use, Safety, and Efficacy of Electronic Documentation and Pain Order Sets

Despite decades of pain research and implementation of guidelines for clinical practice and quality improvement (QI), unrelieved postoperative pain is still a major health problem. Institutional commitment to QI initiatives has resulted in improved pain assessment and prescribing practices, however, there is growing concern that the focus on compliance with quality measures has engendered unsafe prescribing practices and increased the risk for medication errors and adverse drug events (ADEs). Following an opioid-related sentinel event, a local tertiary care center launched a QI initiative to improve analgesia and decrease ADEs by revising policies and procedures for pain management, implementing the use of pain order sets, transitioning to bar code medication administration (BCMA), and modifying electronic medical record (EMR) systems. While the transition to state-of-the-art information technology systems is a critical strategy for improving institutional quality of care, the implementation of each new technology incurs unique systemic and individual challenges. Strategies must be grounded in an appreciation for the complex interrelationship among the structures, processes, and outcomes of pain management. The purpose of this performance improvement (PI) project was to collaborate with nursing and information technology leadership to improve EMR documentation and pain order set capabilities at a tertiary care center. The aims were to enhance patient safety and to ensure nurse and prescriber efficiency and compliance with all aspects of the facility\u27s policies and procedures surrounding opioid administration.