Chronic Pain Management: Implementing Best Practice Strategies
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Abstract
The purpose of this project was to improve the monitoring of chronic pain patients at a rural primary care clinic by creating and implementing a chronic pain flow sheet and pain visit template within the electronic health record. These evidence-based tools were developed using published guidelines regarding the monitoring of chronic pain patients. The clinic has three providers, one physician and two advanced practice providers, and provides primary care along with an extensive amount of chronic pain management. An initial survey was performed on the three providers via a questionnaire along with open discussion regarding their current chronic pain management practice. All providers reported treating chronic pain patients was difficult and the electronic health record was currently not user-friendly when monitoring chronic pain patients. The flow sheet and pain visit template was designed by the project leader (writer) and created by the Computer Information Systems (CIS) department. Once it was created, an initial chart review and flow sheet implementation was performed on a sample population of adult chronic pain patients at the clinic. Providers were educated on the available flow sheet along with the pain visit template available for use. A six-month chart review was conducted to evaluate the project and determined how the flow sheet and template were utilized. A post-implementation survey, similar to the initial questionnaire, was also dispensed and analyzed. Results indicate providers do plan to use the designed monitoring tools but there were some barriers standing in the way of consistent use. The chart review found an increase in presence of pain contracts signed and filed within the last year, but a decrease in the presence of a pain visit within the last four months, urine drug screen within the last six months, and the prescription drug monitoring program checked within the last six months.