pain management at the bedside : implementing the pain resource nurse role at luhs team members:...
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Pain Management at the Pain Management at the BedsideBedside: Implementing : Implementing
the Pain Resource Nursethe Pain Resource Nurse Role at LUHS Role at LUHS
Team Members:• Jackie Murauski, Chair,• Liz Barstatis, Sandy Burgess,
Anita Calistro, Gail Kellberg, Maureen Kolbusz, Cindi LaPorte, Aimee Stotz, LuAnn Vis, Carol White
Loyola University Chicago
LOYOLAUNIVERSITYHEALTH SYSTEM
Opportunity StatementOpportunity StatementFor the past 4 years there have been significant efforts to improve pain management for patients at LUHS. Despite efforts, patient satisfaction with pain management remains in the lower third of hospitals in the Press Ganey database
Project Goal:To bring pain improvement efforts to the bedside, the LUHS Pain Resource Nurse (PRN) role was developed and implemented in 2002.
Pain Resource Nurse RolePain Resource Nurse RoleAn experienced health professional: Staff Nurse, Physical Therapist, Occupational Therapist
Receives special training in pain assessment & management
Develops and implements at least two unit based quality improvement goals for pain management
Serves as resource and change agent for their unit/department
Provides education to peers, patients, and families
Models collaboration with physicians and other health care providers to improve pain management
Most Likely CausesMost Likely CausesBarriers to optimal pain management by staff include:
• The subjective nature of pain• Varied staff knowledge levels related to
optimal pain management• Limited staff involvement in
organizational quality improvement efforts to improve pain management
Solutions ImplementedSolutions ImplementedConducted literature reviewCommunicated with other organizations that have implemented the PRN roleGained organizational support for the programManagers identified PRN candidates (Dec 01)Organized & presented 2 day intensive course on pain management (Jan 02)Conducted a PRN needs assessment (Feb 02)PRN’s conducted a unit based needs assessment (Mar 02)PRN’s developed two unit based improvement goals based on needs assessment (Apr 02)
Solutions ImplementedSolutions ImplementedSupported role through:
Monthly meetings:Continuing education on pain topicsSharing of unit based activities by the PRN’sCommunication of organization improvement activitiesStaff education materialsDevelopment and distribution of LUHS Steps to Unrelieved Pain
Repeated PRN needs assessment after 1 year (Jan 03)Repeated PRN orientation program (Jan 03)
Pain Management At LUHS Steps For Unrelieved Pain
LUHS Vision: All patients at LUHS will receive the best level of pain control that can safely be provided
Patient states that pain is unrelieved with current pain management treatment Patients will be instructed
about their rights and responsibilities for pain management upon admission
Patients will be encouraged to use the pain scale (VAS) to communicate pain intensity
Nurse contacts the intern or resident that wrote the order for change in order
Charge RN, Manager, or Supervisor Considerations: Contact the Attending
Physician Consult with AD, AVP, or
Administrator on Call Consult with Department
Chairman
Additional Resources: Senior resident on
service Attending Physician Charge RN, Manager or
supervisor
AD, AVP, VP or Administrator on Call may coordinate a meeting of the Health Care Team
Staff Nurse Considerations: Provide comfort
measures Enlist family support for
the patient Consult with Unit Pain
Resource Nurse Consult with the
Anesthesia Pain Service Nurses (M-F 7:30am to 4pm @ x64075)
Additional Resources: Senior resident on
service Attending physician
Resident Considerations: Reassess the patient’s
pain Consult the LUHS Pain
management guidelines and orders (EMR & LUCI)
Consider change in opioid, dosage, or the addition of an adjuvant
If pain is unrelieved after 3 changes in the analgesic regimen, consider a consult with the Anesthesia Pain Service (page 68777, #10580)
Ethics Consultation: If at any point in the process, it is believed that there are significant problems with pain management, consider an Ethics Consultation (may require a 24-hour turnaround time for scheduling).
LUHS PRN ProgramLUHS PRN ProgramPRN Comfort Level After One PRN Comfort Level After One
YearYear
0 10 20 30 40 50 60 70 80 90 100
Addiction
Guided Imagery
Equianalgesia
Pediatric Pain
Relaxation
Elderly Pain
Opioid titration
Non Communicative pts
Epidural Pumps
Epidural Nrsg Care
Physiology of pain
Psychological support
Pain goals
Heat & Cold
Opioid Side Effects
PCA Nrsg Care
Respiratory Distress
Pat Advocacy
PCA Pumps
Assessment
Score
2002 2003
Improvement Noted in 18 of 20 aspects of care
Nursing Pain Nursing Pain DocumentationDocumentation
90.5%
69.7%
95.0%
84.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Admission Note Discharge Note
Time
Per
cen
t C
om
pli
ance
Prior to Program After Implementation
AnalysisAnalysisEighty LUHS staff members participate in the PRN rolePRN comfort level has improved in 18 of 20 aspects of pain management after one yearLUHS nursing pain documentation has improved:
Admission notes: increased from 69.7% to 84% complianceDischarge notes: Increased from 90.5% to 95% complianceSeveral PRN’s conduct unit based documentation audits in addition to house-wide indicators
Eighty-six percent of PRN’s report that the role has made a difference on their unit
Next StepsNext StepsContinue to support the PRN role through monthly meetingsProvide continuing education on topics identified through the PRN needs assessmentWork with PRN’s on goal development and presentations of goals/outcomes to unit staff PRN’s will educate peers on “Pain Talking Points” for use in patient/family education in 2003Continue to identify program improvement opportunities