Patient Education in Opioid Use and Pain Management

This project is the result of a partnership between the Michigan Opioid Prescribing Engagement Network (MOPEN) with the Institute for Healthcare Policy Innovation at Michigan Medicine and the University of Michigan Stamps School of Art & Design, Masters of Design (MDes) in Integrative Design program. I co-designed alongside a cohort of five Master's students over the course of a four month semester during the winter of 2018.

Problem

Approach

Observations

Interviews

Our objective was to investigate how to inform, motivate, and support patient behavior which prevents opioid use and abuse at Michigan Medicine University Hospital in order to visualize the current network of patient education to create a shared understanding of the gaps, barriers, and opportunities to improve patient education.

We utilized a human-centered design approach to explore our problem space including on-site observations, interviewing experts, clinical providers, and patients, and leveraging design methods. For our design process we utilized the Double Diamond method focusing primarily
on future strategy recommendations.

1

2

3

4

5

6

7

Expert
Interviews

On-site
Observations

Primary
Interviews

Patient
Survey

Patient
Workshop

Data
Synthesis

Final
Report

DISCOVER

DEFINE

DEVELOP

DELIVER

A.E.I.O.U.

P.E.O.M.S.

Survey

Patient Journey Map

Experience Matrix

Generative Workshop

Final Report

We conducted a combined total of 30 hours of observations within Michigan Medicine including the University Hospital Pre-Op Clinic and PACU, East Ann Arbor Ambulatory Surgery and Medical Procedures Center Pre-Op and PACU, Domino's Farms Pre-Op Clinic and the Von Voigtlander Women's Hospital. Our observations focused on gaining a deeper understanding of the patient experience by mapping each stage of the patient journey and documenting who, when, how, and where patient education is delivered. 

IMG_1079.JPG

Through discussions with providers we identified six stages within the patient surgical journey as shown below. We used these stages as a framework to determine our observation strategy and organize our initial observations.

BEFORE SURGERY

Surgical Consult

Pre-Op Clinic

DURING SURGERY

Pre-Op Hold

PACU / In-patient
Discharge

AFTER SURGERY

Follow Up Call

Post-Op Visit

21

15 Patients

4 Physician Assistants

2 Nurses

We observed a total of 20 patient visits across a variety of surgical procedures including new

pilot interventions addressing patient education. Through our observations and interviews we identified the patient emotional experience varies greatly within each stage of the journey. For instance, patients are often worried and anxious about their upcoming surgery during the pre-op clinic visit as they are overloaded with technical information in a short period of time. 

Patient
Survey

Patient
Workshop

Insights

Outcomes

Conclusion

Through a partnership with the Office of Patient Experience at Michigan Medicine, we survey patient advocates to gain deeper insight into the patient experience for those who had received surgery within the part two years. 17 patients responded with the following highlights:

Anticipated pain level is often higher than actual pain
Most patients (>50%) believe opioids are necessary
Patients often retain pills to be used for future pain
There is limited awareness of how leftover pills can affect those around them 
Overwhelmingly patients prefer to have a discussion with their provider to receive information.
"If I had a conversation with my doctor
about the effects of opioids, it would
affect my behavior…"
- Patient Survey Participant

Building on the patient interviews, it became clear further investigation was need to gain a broader understanding of the patient experience throughout their surgical journey. Understanding the emotional state at a deeper level can assist in generating education content which resonates with patients and is key to identifying their needs in making informed health decisions. Four PFCC E-Advisors who had received surgery within the past two years joined the MDes team to work on activities aimed to recall their patient experience.

Activity One: To assist patients in remembering their experience within three stages of the

surgical journey: before surgery, in the hospital, and after surgery as it relates to who they

met, what they learned, how they felt, and who they spoke with, among others.

DSC_2188_edited.jpg

Examples of cards with emotions, people, places and objects to facilitate the conversation.

Activity Two: To assists patients in identifying their ideal surgical journey including who they

wish they had met, what they wish they were told, what they wish they had learned, what

they wish they had felt, and how they wish they managed their pain.

DSC_2200_edited.jpg

Prompt to encourage patients to discuss their experience and how they wished it was.

Activity Three: As a group patients reviewed all currently available education materials the

MDes team had identified during the observations.

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Katherine Jones facilitates a discussion regarding the pros/cons of current educational materials.

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Patient Experience Matrix.

1. Both discussion with a provider and education materials to take home are valuable and influential.
2. It is important to have different information at each stage which is relevant to the experience and needs of the patient at that stage.
3. Reinforce the same patient education message throughout the whole journey to ensure retention
and limit confusion. Patients receive varying degrees of content at each stage which can contradict
the previous education.

To deepen patients understanding of the reality of post surgical pain, it is recommended to

introduce and discuss pain expectations and management strategies at the pre-op clinic visit.

Introducing this content early on gives patients time to establish a plan for managing their

pain as well as being able to learn about their specific needs from the beginning.

BEFORE SURGERY

DURING SURGERY

Surgical Consult

Pre-Op Clinic

Pre-Op Hold

PACU / In-patient
Discharge

AFTER SURGERY

Follow Up Call

Post-Op Visit

Expect Pain

(introduce + discuss)

How to Manage Pain
(introduce + discuss)

At the hospital stay, patients are the most alert during the pre-op hold stage and can be

educated about opioid and pain management. Moreover, nurses spend more time with patients

and caregivers during the this stage allowing the space necessary to reinforce previous pain

expectations and management strategies while introducing and discussing the healing process

and tapering protocols.

BEFORE SURGERY

Surgical Consult

Pre-Op Clinic

DURING SURGERY

PACU / In-patient
Discharge

Pre-Op Hold

AFTER SURGERY

Follow Up Call

Post-Op Visit

Expect Pain

(reinforce)

How to Manage Pain
(reinforce)

Healing Process
(introduce + discuss)

Tapering

(introduce)

Upon arriving home, patients often felt neglected as they no longer had immediate access to their care time. This stage is an opportunity to proactively contact patients to reinforce previous educational content as well as discuss relevant issues such as tapering and opioid disposal. This will give important context to patients regarding opioid management as well as improve the patient experience.

BEFORE SURGERY

Surgical Consult

Pre-Op Clinic

DURING SURGERY

Pre-Op Hold

PACU / In-patient
Discharge

AFTER SURGERY

Follow Up Call

Post-Op Visit

Expect Pain

(reinforce + discuss)

How to Manage Pain
(reinforce + discuss)

Healing Process
(reinforce)

Tapering

(discuss)

Disposal

(introduce + discuss)

By investigating the patient experience through the surgical journey stages we came to recognize the need for individualized patient centered education which identifies the risks of opioid use and pain

management. This should be reinforced throughout each patient’s journey as it relates to the specific surgical procedure as well as the patient’s needs. 

 

We presented our final recommendations to our partners M-OPEN and MPrOVE and stakeholders from Michigan Medicine. Two MDes students continued this project in the following year for their thesis project including prototyping and testing new tools with Dr. As-Sanie to improve patient education.

"Thank you so much for the opportunity to work with your team. 
Your work really identified some important issues surrounding
perioperative pain education and management, and I hope
we get a chance to continue to work in this area."
- Dr. Susie As-Sanie with Michigan Medicine