Baseline Evidence-based Analgesia, Not Substitutes (BEANS): Implementation of Evidence-based Multimodal Pain Control at an Inpatient Rehabilitation Facility

Background and/or Objectives: Acute pain management is a significant determinant of clinical outcomes, patient satisfaction, and longitudinal quality of life. Correspondingly, an evolving body of literature exists on the importance of acute pain control. Consensus evidence-based guidelines from multiple medical organizations on pharmaceutical analgesia advocate for multimodal regimens. While personalized pain regimens remain important due to high variability in patient response, it is generally agreed upon that acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) are first-line agents. In the setting of a nationwide opioid epidemic, it remains increasingly important to optimize pain control with judicious use of opioid agents. Despite this, various barriers exist to implementation of multimodal regimens and many facilities still rely primarily on opioids for analgesia. In this study, we attempt broader implementation of multimodal analgesic regimens at a 14-bed inpatient rehabilitation facility (IRF), as well as report barriers encountered, in an attempt to improve pain outcomes and reduce opioid burden.

Design: After evaluation of possible barriers to multimodal pain regimens, various initiatives will be implemented and optimized as we continue to receive feedback and analyze outcomes.

Setting : 14-bed IRF within an acute care hospital

Participants : Patients of above.

Interventions: Early trials include provider education, increasing scheduled medications, alternatively worded PRN orders, potential order sets in EHR, and more.

Main Outcome Measures: Primary outcome is reported pain outcomes.. Secondary outcome measures include total opioid dosing, patient experience, length of stay,

Results: We are still early in the study, but retrospective review of the population from 1/1/24 (n=241) compared to post implementation (n=245) has shown a 19% reduction in oxycodone use and a 50% reduction in tramadol usage, the two primary PO opioids. No significant reductions were made to their availability as PRN medications. Pain outcomes have remained equivocal.

Conclusions: Early applications of multimodal regimens at this IRF are promising, demonstrating marked reductions in opioid burden without significant differences in pain outcomes.