During 2020 to present day, a sub group of the greater UCSF Health pain management committee came together to devise and implement a standardize approach in creating a standardized tiered approach in assessing and treating a patient's pain using a holistic lens that focus' on the patient's function.

Background
PRN pain medications were prescribed and administered based on a generalized assumptions about patients’ subjective pain intensity scores. Wide variability existed in nursing practice when determining what PRN analgesic medication and dose to administer. Many institutions experienced regulatory findings when RN administration of PRN pain medications did not align with patient’s pain intensity scores (often prescribed as mild = 1-3/10, moderate = 4-6/10, severe pain = 7-10/10).
Problem Statement
Scientific literature dating back to the early-mid 2000’s has raised issues about over-prescribing and over-administering opioids for the treatment of pain.
Gap Analysis
Will a new multimodal PRN pain order and framework endorsing holistic nursing pain assessments help close the gap that lies between safe and appropriate pain management and adequate analgesia?
Project Plan
1. Start with a comprehensive literature review. 2. Contact systems who were early adopters  3. Form a local interdisciplinary team. 4. Consider routine holistic, patient-centered pain assessment considerations. 5. Encourage routine use of nonpharmacological interventions.  6. Create new orders that consider the multimodal approach. 7. Educate clinicians, patients, families, and caregivers. 8. Follow the Plan-Do-Check-Act (PDCA) model of process improvement. 9. Disseminate.
Conclusions
The project suggests that safer, yet equally effective pain management is possible when orders are written as a tiered approach and assessments are conducted with a holistic lens that focus' on patient function.