PIG-NI NEWSPain Interest Group Nursing Issues

Newsletter July 2016

This edition

• PIGNI Chair

• National Ambassador

• Editor’s Message

• A Pioneer Retires

• Toula’s Story

• PIGNI 2016 AnnualProfessionalDevelopment Day

• PIGNI 2016 RuralScholarship

• A chat with ToulaKranitis

• The Middle Wife

• 2016 Committee

All correspondence tonewsletter editor:

Lee BeestonLee.Beeston@health.nsw.gov.au

Newsletter sponsored by

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Sandra TuttChairperson, Pain Interest Group Nursing Issues

Half way through the year and has it not flown?

Have you registered for the October NSW PIGNI annualconference? This will be our 10th annual conferenceand we hope to see as many members and colleaguesthere. It promises to be a great day. Be an ambassadorfor pain management awareness in your hospital!

Are you aware that it’s National Pain Week 25th – 31stJuly, 2016? This is an annual event and more information can be found onwww.nationalpainweek.org.au

It may be too late to plan celebrations this year but think about planning fornext year.

Lee and the Newsletter team have put together an interesting collection ofarticles for you to read. They work hard to bring you this quarterlynewsletter. I hope you enjoy it.

I would like to thank, our sponsors of the NSW PIGNI newsletter, Hospira,now a Pfizer company, who have been sponsoring this newsletter for over 20 years and have been a great support to the PIGNI group.

Sandi

Dear Members,

As we endure a cold winter, be inspired today in our primary focus of thenewsletter, a heart-warming story from a pain a management nurse whoknows pain personally and professionally.

Toula Kranitis generously shares her experiences and by so doing,encourages us all to look to the heart of who we are and how we can best bean ambassador for pain management where we work, live and serve others.Toula has generously provided slides of the talk she gave staff at a healthcarefacility for people with disabilities which we may use.

Another great ambassador for pain management has retired! ProfessorMichael Cousins.

Editor’s Message April 2016

“I would like those suffering with chronic pain to know, I feel your pain andit’s ongoing. But, I now know it is all about learning as much as you can tomanage your pain as effectively as you possibly can.”

Chronic Pain Australia, National Pain Week (25 – 31 July 2016)promotes four core aims.

National Ambassador Michael Clarke

PIGNI Chair

Editor’s Message

Have a Look at This!

I Think We Need to Rename “Chronic Pain”

Innovate Method: TheGroupEffectfor Pain Management StepsforPainRelief

Vitamin D Status in theBurnPopulation atConcordHospital

Methoxyfluraneinthe Outpatient Setting

PrinceofWales Hospital,Randwick, Pain Management Service

PIGNI Committee List

Bernadette Bugeja, Chairperson, Pain Interest Group Nursing IssuesWelcometothewinter/springedition.

ThePainInterestGroupNursingIssueAnnual

ProfessionalDevelopmentDayonthe27thOctober

registrationisnowopen.Excitingthingsare

happeningwithaconferenceapptobeusedonthe

daycurrentlyunderdevelopment.Earlybirdregistrationfortheconference

closesonthe29thSeptember.Gotowww.pigni.org.autoregister.

Onthelinesofeducation,IthoughtI’dletyouknowaboutafewresources

availableonMyHealthLearningrelatingpainmanagement:

- AcutePainManagementforAdultscoursecode78572002

- PainAssessmentcoursecode66247854

- PatientControlledAnalgesia-AdultPainManagementcoursecode

40063903

- AbbeyPainScalecoursecode89858565

MyHealthLearningisavailabletoallNSWHealthemployeesandfocuses

onself-managedonlinelearning.

TheInternationalAssociationfortheStudyofPainhasreleasedtwo

interestingClinicalUpdatesonPreventingandtreatingmedicationoveruse

headache(June2017)andAcutepainmanagementinpatientswithdrug

dependencesyndrome(April2017).

Ihopeyouenjoyreadingthiseditionofthenewsletter.

Bernadette

Bernadette BugejaChairperson, on behalf of Pain Interest Group – Nursing Issues

Newsletter September 2017

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Professor Michael J Cousins AO has devoted hisentire career and much of his personal life toimproving the lives of people living with pain. His selfless commitment to this goal over the pastfour decades has led to a new understanding ofchronic pain as a disease in its own right. ProfessorCousin’s advocacy has prompted governments inAustralia and internationally to recognise pain as a health care priority.

Professor Cousins graduated from University ofSydney, specialised in Anaesthesia and studiedoverseas on a Fellowship in 1969-1970. While atMcGill and Stanford Universities, he interacted withthree of the pioneers in the field of Pain Medicine:Ronald Melzack and Patrick Wall, who in 1965proposed the revolutionary “Gate Control Theory of Pain”, and John J.Bonica the FoundingFather of the teamapproach to painmanagement.

PMRIShortly after returningto Sydney early in the1990s ProfessorCousins set up thePain ManagementResearch Institute(PMRI) Ltd which is a not for profit, taxexempt communitybased organisationwhich raises funds for the research andeducation activities of PMRI, as well asother activities whereappropriate.

ADVOCACY and POLICY REFORMIn March 2010 Professor Cousins chaired theSteering Committee, which developed Australia’sfirst National Pain Summit at Parliament House,Canberra. The Summit brought together 150healthcare and consumer organisations whoworked together to develop the National PainStrategy, approved unanimously at the Summit.Following the Summit, he spearheaded theformation of a new organisation, Painaustralia,which acts as an advocacy body to facilitate theimplementation of the Pain Strategy.

In Australia, Professor Cousins was the FoundingPresident of the Australian Pain Society (1979),Chairman of the Joint Advisory Committee on PainMedicine of the specialist Colleges of Anaesthesia(ANZCA), Medicine (RACP), Surgery (RACS),

Psychiatry (RANZCP) and Rehabilitation Medicine(AFRM) which led to the formation of the Faculty ofPain Medicine (FPMANZCA) in 1999. He served asthe Founding Dean of the Faculty of Pain Medicine(1999-2002), which is currently unique worldwidein bringing together five speciality bodies tooversee a single training program and examinationleading to a specialist qualification in PainMedicine. He also played the leading role withFaculty of Pain Medicine colleagues, in gainingrecognition of Pain Medicine as a medical specialityby the Australian Government in 2005.

MULTIDISCIPLINARY PAIN AMAGEMENTCENTRES Professor Cousins developed two largemultidisciplinary centres in Pain Medicine, atFlinders Medical Centre, Adelaide (1975-1990) and

at The University ofSydney, Royal NorthShore Hospital(1990-present).

EDUCATIONProfessor Cousinsalso fostered thedevelopment of aUniversity of SydneyGraduate Diplomaand Masters post-graduate degree inPain Management,which now enrolsstudents from acrossAustralia and aroundthe world in a web-based educationprogram for all healthprofessionals, whichis unique worldwide.

INTERNATIONALASSOCIATION FOR THE STUDY OF PAIN(IASP) Professor Cousins is the only Australianand the first Anaesthetist after the Founder John J. Bonica to serve as President of theInternational Association for the Study of Pain(IASP) (1987-1990).

His book on “Acute Pain Management in CriticalCare” with Garry Phillips (1986) was the first onthis subject.

ANZCAIn the Australian & New Zealand College ofAnaesthetists (ANZCA), Professor Cousins servedas the Councillor 1995-2006, Vice President 2003-2004 and President 2004-2006. He re-organisedthe ANZCA Foundation and served as its Chair.

Major initiatives during his Presidency were:

A Pioneer Retires

2

Have a Look at This!

Editor’s Message September 2016HelloPIGNIMembers!Thereisawealthofinformation,helpfulreferencesandresearchoutcomesinthiseditionofthenewslettertokeepyoureadingwithavidinterest!

ThiseditionhastwoarticlesformtheLismorePainClinicTeam,oneofwhomisaclinicalpsychologistpromptingustothinkaboutthename‘pain’.WetrusttheoutlineofpainclinicactivitiesinLismoreandPrinceofWales,Sydneyishelpful.Havinganursepractitionerpresenthisresearchonstomaltherapycareusingmethoxyfluraneinhaledanalgesia.

Yourfeedbackisverywelcomeanditwouldbeencouragingtohaveinthenexteditionsomecommentsonthearticleswithinthisedition.

Don’tjustthinkit,writeit!

Lee Beeston

• The Australian Pain Management Association, https://www.painmanagement.org.au

APMA, is a registered health charity and was established in 2009. APMA offers a voice, support and information for the Australian consumer who live with pain.

Oneoftheirmanyresourcesisahelpfulbrochurefortheconsumervisitinganemergencydepartment: https://www.painmanagement.org.au/images/painman/PDFs/Persistent-pain-and-emergency-department.pdf

Forthepatientwithchronicpainitsimplyexplainswhata‘flareup’inpainisandgivesstrategiesforitsmanagement.ItgivesaclearlistwhenavisittotheEDisrecommended,suchasurinarybowelincontinence,paralysis,newlossinsensation,andinjuryorflareupafterroadaccidents.Italsosuggests that the emergency department is to treat patientswhoaresufferingfromacuteseriousillnessor injury and suggest that the ED is not designed to provideongoingcarewithchronicpainandavisitmayresultinalongwait.

• The impact of codeine re-scheduling on misuse: a retrospective review of calls to Australia’s largest poisons centreRoseCairns1,2,JaredA.Brown1&NicholasA.Buckley1,2

NewSouthWalesPoisonsInformationCentre,TheChildren’sHospitalatWestmead,Westmead,NSW,Australia1andClinicalPharmacologyandToxicologyResearch

• Consumer fact sheet :Codeine-containing medicines AustralianGovernmentDepartmentofHealthTherapeutic Administration

What’s changing? From 1 February 2018, medicines that contain codeine will no longer be available without prescription.

Your pharmacist will be able to help you choose from a range of effective products that do not require a prescription. If you have strong or chronic (long-lasting) pain you will need to consult your doctor, and if medicines are part of your treatment, a prescription may be needed.

The sheet covers the following topics:Harmsandchangestopatientaccess;whyaccessischanging;codeineusecanbeharmful;howandwheretogetadvice;talktoyourdoctor;nextsteps

• Update codeine safety and efficacy review January2015toNovember2016version1.0,December2016.(TGAHealthSafetyRegulation)

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I Think We Need to Rename “Chronic Pain”!What’sinaname?Well,thesetwodescriptivewordsevokeasenseofdreadtopeoplewithoutpain,letalonethoselivingwithpersistentpain.Andhowmanypeopleknowwhatthedifferenceisbetweenchronicandacute?Evenmanyhealthprofessionalsdon’tgetitright.

Wedon’tcallasthma“chronicrespiratoryinflammation”ordiabetes“chronichighbloodsugar”.Whenwehearthewords“asthma”or“diabetes”,mostpeoplewouldhaveanideaofwhatitisandperhapsmanywouldhaveagoodideaoftreatmentoptions.

So,Iproposewerenamechronicpaintosomethinglike‘perdolor’–acombinationofpersistentpainanddolor(latinforpain).Whensomeoneisdiagnosedwith‘perdolor’theycouldbeprovidedwithinformationabouttheirconditionandthendirectedtoevidencebasedtreatmentoptions.

Pharmaceuticalcompaniescouldbeheldliableiftheymarketpainmedicationswithoutevidencefortreating‘perdolor’.Advertisingcouldbemoreregulated–claimsto“erase”‘perdolor’wouldbemoredifficulttosubstantiatethanthecurrentambiguoususeoftheword‘pain’.

Couldyouimaginethesavingsforgovernmentwithclearguidelinesfor‘perdolor’treatment.Theroundaboutofimaging,referrals,treatments,medicationsfor‘perdolor’wouldneedtobesubstantiated.

NowIdon’timagineanamechangeforchronicpainwouldbeeasy.Thedefinitionofchronicpainwasarguedworldwideforyears.So,changingthetitleofchronicpainwouldbeamonumentalchallenge.Iamnotevenparticularlyattachedtomytongueincheektitle‘perdolor’.Farmoreworthypeoplethanmecouldargueforyearstocomeoverthis.

However,aslongasweareusingtheword‘pain’asadiagnosisratherthanasymptom,therewillcontinuetobeconfusionaboutthecondition,anduncertaintyregardingcorrecttreatmentoptions.Andthebottomlineisthattheaveragepersonsufferingwithchronicpain,willcontinuetodojustthat–suffer.

Kris Keevers Clinical Psychologist, Lismore Pain Clinic

2018 Australian Pain Society 38th and New Zealand Pain Society Conjoint Annual Scientific Meeting

8–11 April 2018 | International Convention Centre, Sydney | Australia

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Innovate methods: The Group Effect for Pain Management Steps to Pain Relief

Group Programs

Pre-Assessment Education:INSIGHT

• 3-hourgroup-based“introduction”sessionto servicesprovidedbyLismorePainClinic

• INSIGHTisruntwiceamonth

• Thisprogramhasdevelopedintoan Interdisciplinarysession

• Duringthesessionpatientsdevelopa“Pain ManagementActionPlan”whichhasbeenadapted fromthe“HealthPlan”offtheACIwebsite

• Attheendofthesessionpatientshavethe choiceto“Opt-In”andprogresstheirreferral withintheclinic

• Afterthesession,forthosepatientswho “Opt-In”,theMultidisciplinaryTeamwho conducted the session triage each patient

• Patientsaretriagedbasedon:

o Presentation on the day

o ePPOC data

o MedicalReferral

o Thosepatientswhomaybemorecomplex withhighopioids,highpsychometricswillbe triagedtogotoaMultidisciplinary Assessment

o Patientswhoarenotascomplexwillbe acceleratedthroughtoa30minutePhysio/ Psych Assessment

o TheideaoftheacceleratedAxpathwayis:

1. reducestheamountofnumbersonthe waitinglistand

2. allowspatientstobefilteredthrough quicker

Treatment Programs:IMPROVE

• 24-hour(6weeks,4hours,onedayaweek) mediumintensitygroupbasedprogram

• Located: Northern NSW Physiotherapy departments

• IMPROVEoriginatedasaresultofmultiple factors:theneedforanotherprogram, consultationwithbothconsumersand physiotherapistsatlocalphysiotherapy departments.

• Consumersreportedchallengestoaccessing treatmentatLismoreandlocalphysiotherapy departmentswantedawaytoimproveservice deliveryforthosewhohavechronicpain

• IMPROVEisa‘hubandspoke’modelrunbya psychologistfromourpainclinictohelp standardize the service and a physiotherapist fromthelocalphysiodepartment

• Localphysiotherapistsarementoredbythe physiotherapistfromthepainclinic

• Theideaisthatbybringingthepainmanagement programstothecommunitywecanreachthose patientsthatwouldotherwisehaveahardtime accessingservicesinremoteareasandupskill localphysiotherapistswithpainmanagement treatment

• IMPROVEisverymuchanongoingworking relationshipbetweenthepainclinicand PhysiotherapistsacrosstheLHD.Patientsare acombinationofpatientsreferredandassessed bythepainclinic,andpatientsreferreddirectlyto physiotherapydepartmentsbytheirGP.

• Thepatientprofileisgenerallythosewhohave lessrelianceonopioids,lowerpsychometricsand aregenerallyhigherfunctioning.

• IMPROVEhasbeenatreatmentoptionforthe past2years.21programshavebeencompleted andweaimtorunatleast10programsayear.\

continued on next page..

WhatChangesHaveWeMadetoprovidingtreatmentinaPainManagementClinictreatingpatientswithChronic Pain?

Changesto:ServiceDeliveryModelandProgramContentandDelivery

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Innovate methods: The Group Effect for Pain Management Steps to Pain Relief (continued)IMPACT

• 96-hour(3weeks,4daysaweek)highintensity groupbasedprogram–LocatedatLismorePain Clinic

Content and Delivery of both IMPROVE and IMPACT• AllworkbooksareataGrade7readleveltokeep themessagesimplewhilestillbeingeffective•Weuseavarietyofeducationmediasuchas videos,whiteboardwork,demonstrationsto targetthedifferenttypesoflearningstyles• Someadditionaleducationalsessionsincludeare fearavoidance,‘scarywords’andneuroplasticity• ForsomeeducationalsessionsduringIMPACTand forallsessionsduringIMPROVEare interdisciplinaryaswehavefoundhavingatleast 2cliniciansmoreeffectiveasateachingmethod

• Encourage“clientdriven’sessionswithinformal chatssuchas“Q&Asessions,“askus”and usingthe12-minutewalktochattoeachpatient individually

Additional Innovative Services

• EngagementwiththeAboriginalcommunity througheducationsessionstobothHealthCare WorkersandCommunitymembersandmonthly clinicsatthelocalAMS• Engagewiththecommunityandhealthservices byprovidingeducationdaysonthetreatmentof chronicpainforexampleLifeline.

David Beveridge Nurse Practitioner, Manager Lismore Base Hospital Pain Clinic

VitaminDhasemergingrolesinpainsensation,pruritisandmusclefunction.PatientsareatpotentialriskofvitaminDdeficiencypostburninjuryduetoreducedvitaminDsynthesisinthedamagedskin,prolongedhospitalisationandongoingscarmanagementlimitingUVexposure.VitaminDdeficiencyhasbeenrecognisedinpaediatricburnspatients.However,thereislimitedpublishedevidenceintheadultpopulation.

Aim TodeterminetheprevalenceofvitaminDdeficiencyfollowingsevereburninjury.

Methods Aretrospectivemedicalfilereviewofallpatients≥18yo,admittedtotheConcordBurnsUnitwithsevereburns(≥20%TBSA)between2011and2015.Patientcharacteristics,burndemographicdata,bloodresultsandprescribedvitaminDsupplementationwerenoted.Patientspalliatedwithin7dayswerenotincludedintheanalysis.SerumvitaminDdeficiencywasdefinedbytheAustralianandNewZealandBoneandMineralSocietyandOsteoporosisAustralia.

Results 115patientsmetthestudycriteria,74%weremalewithburnareabetween20-90%TBSA.Ofthese,27(24%)hadaserumvitaminDlevelmeasuredaspartoftheirburnmanagementeitherduringtheirhospitalisationoroutpatientfollow-up.OverhalfofthepatientshadaserumvitaminDlevel<50mmol/L.

Discussion AlthoughthepotentialforvitaminDdeficiencyisrecognised,itiscurrentlynotwellmonitoredgivenonly24%ofthestudypopulationhadvitaminDmeasured,and56%ofthemweremildlyormoderatelydeficient.FurtherresearchiswarrantedintomonitoringofvitaminDlevelsandpossiblesupplementationregimensgivenvitaminDstatusisamodifiablefactortoimproveoutcomesfollowingburninjury.

Key Words VitaminD,Adultburninjury

Caroline Nicholls, Nicola Riley, Alison Crosbie, Peter MaitzDept Nutrition and Dietetics, Concord Repatriation Hospital, Concord

Vitamin D status in the adult burn population at Concord Hospital

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Methoxyflurane in the Outpatient Setting

Methoxyfluraneinhaledanalgesiawasusedtomanagepainduringwounddressingchangesfora37yearoldmalewithchronicperianalwoundandfistula.Thefistulaoccurredfollowingananalfissurerepairwhileoverseasina‘developing’countrytwo(2)yearspriortopresentationforreviewatthisfacilitywithperianalsepsis.Heunderwentfour(4)surgicalprocedurestocontroltheperianalsepsis,layopenthefistulatrackandinsertsetondrains.Duetoongoingsepsisthedecisionwasmadetoperformadefunctioningloopcolostomytodecreasefaecalcontaminationoftheperianalwound.

Amultitudeofpathology,microbiology,endoscopic,radiologicalandclinicalexaminationswereperformedtodetermineadiagnosis.Allfailedtodetermineacause.Commoncausessuch Crohn’s disease and more rare conditions likegastrointestinaltuberculosiswereexcluded.Intheensuingthree(3)yearsafurther21examinationsunderanaesthesia,drainagesofcollections,debridementsandchangeofsetonwereperformed.Secondandthirdopinionsweresoughtfromothertertiaryreferralhospitals.

AMRIrevealedacomplexhighfistulawithasecondarytractextendingtogluteusmaximus.Therewasongoingdischargeandfibrosisadjacenttoexternalopeningintheleftbuttock.Afistulectomyincludingthesecondarytract,anexcisionofthelargefibroticmassandachangeofsetonwasperformed.Thisleftadefectintheleftbuttockwithdimensionsof9cmindepth,7cminlengthand3.5cminwidth.Topicalnegativepressurewoundtherapy(TNPWT)wasappliedtothewoundattheendofthesurgicalprocedure.Thechallengeswereexacerbatedasthepatienthadbeenunabletomaintainemploymentduetotheongoingsepsisandneedforfrequenthospitaladmissionsandsurgicalprocedures.Thiscausedfinancialpressuresandrelationshipproblems,resultingindepression.ThepatientwasreferredtoClinicalPsychologyforongoingreviewandsupport.

Two(2)subsequentTNPWTdressingchangeswereattendedundergeneralanaesthesiawhereconcurrentwoundexaminationswereperformed.Inanefforttominimisetheneedforfurthergeneralanaesthesia,futuredressingchangeswerecarriedoutintheStomalTherapyOutpatientClinic.ThemajorityofthesurgicalproceduresandTNPWTdressingchangeswereattendedonadayonly/out-patientbasistominimisedisruptiontothepatient’slifeasheistheprimarycarerforhisyoungchild.

Self-administeredmethoxyfluraneinhalationwaschosenforitsstronganalgesicpropertieswhichmettherequirementsforthispatientanddressingchangeswerewelltolerated.ItisrecommendedinhaledMethoxyfluranebelimitedtoamaximumdailydoseof6mlandatotalof15ml/week.UseonconsecutivedaysisnotrecommendedandinhaledMethoxyfluraneiscontraindicatedinpatientswithrenalfailureorrenalimpairment1.Thispatientrequired3mlofinhaledMethoxyfluraneforeachTNPWTdressingchangeandthiswaslimitedtotwiceweekly,withrenalfunctioncheckedweekly.Assessmentofchronicwoundsshouldincludepainreview,withnarcoticstaperedasappropriate.

InhaledMethoxyfluranecanbeusefulformanaging the acute pain experienced during dressingchangesintheoutpatientsetting.VAC®whitefoamwasusedforTNPWTasitwaslesspainfulonremovalthanVAC®Granufoam.TNPWTcontinuedfor23daysandMethoxyfluranewasnotrequiredforsubsequentdressingchanges.

TheuseofMethoxyfluraneenabledTNPWTdressingchangestobeperformedintheoutpatientsettingduringtheacutephaseofwoundhealing.Thisdecreasedtherequirementtousecostlyoperatingtheatretime,reducedtheneedforgeneralanaesthesiafordressingchangesandshortenedthelengthofhospitaladmission.Thisallowedthepatienttocontinuetoattendtohisparentingresponsibilities.TheshorttermuseofMethoxyfluranewasapositivecomponentinthecomplexcareofthispatient.

Presently,thepatientstillhasacolostomyandhastwosetondrainsinsituwhicharecontrollinghisperianalfistulaeandpreventingsepsis.Theperianalwoundremainshealed.

1. Gaskell AL, Jephcott CG, Smithells JR & Sleigh JW. Self-administered methoxyflurane for procedural analgesia: experience in a tertiary Australasian centre, Anaesthesia, 2016, 71, 417–423.

Ian Whiteley Nurse Practitioner: Stomal Therapy/WoundConcord Hospital, NSW

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Prince of Wales Hospital, Randwick, Pain Management Service

TheDepartmentofPainManagement,atPrinceofWalesHospital,isaTier3MultidisciplinaryPainServicewithPainStaffSpecialists,Psychiatry,AddictionStaffSpecialist,Psychology,Physiotherapy,OccupationalTherapy,Nursing,ResearchOfficerandSecretary.Acuteandpersistent pain services cover inpatients and outpatients.

TheDepartmentprovidesmultidisciplinarypainmanagementusingteleconferencestodiscusscomplexpatientswithShoalhaven,PortKemblaandWollongongHospitals.

In2016,of161newpatients68%hadmultidisciplinaryassessments,2280patientsseenasfollowups.322interventionalpaintherapieswereadministeredintheatres-32intrathecalpumpsandneurostimulatorimplantations,trialorrevision.134patientscompletedgroupsessions-arttherapy,hydrotherapyandmediumintensitypainprogram.

TheAcutePainservicehasAnaestheticRegistrar,AnaestheticResident,AcutePainNurseandalternatingDutyAnaesthetistandPainConsultant.OutofhoursiscoveredbyoncallAnaestheticRegistrarandPainConsultant.In2016acutepainroundssaw1547newpatientsreviewedonPCA,16onepidural;and176patientswereconsultsi.e.startedonoralopioid,Ketamineetc.

Nursesworkinginthemultidisciplinarypainprogramgivetalksonsleepandmindfulnessandfacilitatethe9weekoutpatientmindfulnessprogram1.5hoursonceaweek.Contributingtodepartmentalresearch,nursesruntrialsforTranscutaneousElectricalNerveStimulation(TENS),neurostimulationandintrathecalpumps,andaretrainedtorefillpumpsonfollowupwith143refillsin2016.Theyarealsoskilledintranscranialdirectcurrentstimulation(tDCS)forthetreatmentofpatientswithmigraines.NursescoordinateTelehealthwithpatients,GPsandthepaindepartmentclinicians.

Pain Management nurses provide ongoing nursing educationregardingPCA,Ketamine,ContinuousOpioidInfusion,NeuraxialandIntrathecal.Educationpackagesdevelopedinclude:“PCAonlinelearning”priortopracticalassessment,andalso“HYDROmorphone”inresponsetoNSWHealth’ssafetyalert,andalsoforAlliedhealthasrequired.QualityprojectsincluderepeatauditsofPCAandKetaminestatepaincharts.In2016,ourworkwithunitstoimprovedocumentationwaspresentedattheEssentialsofCareShowcase.

Reported by Bernadette Bugeja and James Tekiko

Perspectives of Pain

Perspectives of Pain

Professional Development One-Day Program

Professional Development One-Day Program, Friday 27th October 2017Sydney Masonic Centre

F O R M O R E I N F O C O N T A C T

DC Conferences Pty Ltd

E pigni2017@dcconferences.com.au

P 02 9954 4400 | F 02 9954 0666

W www.dcconferences.com.au/pigni2017

On behalf of the 2017 organising committee,

I would like to invite you to be part of the Pain

Interest Group Nursing Issues (PIGNI) Annual

Professional Day.

The theme Perspectives of Pain will cover a

varied program with local and national experts

addressing evolving issues in acute and chronic

pain. The day provides an opportunity to

network and meet others who have an interest

in pain management.

Bernadette BugejaChairperson, Pain Interest Group Nursing Issues

You are invited…

G O L D S P O N S O R S G O L D S P O N S O R SPerspectives of Pain

Perspectives of Pain

Professional Development One-Day Program

Professional Development One-Day Program, Friday 27th October 2017Sydney Masonic Centre

F O R M O R E I N F O C O N T A C T

DC Conferences Pty Ltd

E pigni2017@dcconferences.com.au

P 02 9954 4400 | F 02 9954 0666

W www.dcconferences.com.au/pigni2017

On behalf of the 2017 organising committee,

I would like to invite you to be part of the Pain

Interest Group Nursing Issues (PIGNI) Annual

Professional Day.

The theme Perspectives of Pain will cover a

varied program with local and national experts

addressing evolving issues in acute and chronic

pain. The day provides an opportunity to

network and meet others who have an interest

in pain management.

Bernadette BugejaChairperson, Pain Interest Group Nursing Issues

You are invited…

G O L D S P O N S O R S G O L D S P O N S O R S

Perspectives of Pain

For further information please contact the PIGNI 2017 Conference Secretariat: DC Conferences Pty LtdSuite 103, Level 1, 3-5 West Street, North Sydney NSW 2060, Australia | PO Box 637, North Sydney 2059

P 612 9954 4400 | F 612 9954 0666 | E pigni2017@dcconferences.com.au

8

2017 PIGNI Committee ListChairperson:Bernadette BugejaPrince of Wales HospitalBernadette.Bugeja@health.nsw.gov.au

Alternate Chairperson:Vicki CrockerTamworth Rural Referral Hospitalvickie.croker@hnehealth.nsw.gov.au

Secretary:Kate LancasterSt Vincent’s Health NetworkKate.Lancaster@svha.org.au

Alternate Secretary:Toula KranitisCanterbury Hospitaltoula.kranitis@sswahs.nsw.gov.au

Alternate Secretary 2:Denise WilsonConcord Repatriation General Hospitaldenise.wilson@sswahs.nsw.gov.au

Treasurer / Mailing List Co-ordinator:Sonia MarkocicWollongong HospitalSonia.Markocic@health.nsw.gov.au

Alternate Treasurer / Mailing List Co-ordinator:Sue LeeSt.George HospitalSusan.Lee1@health.nsw.gov.au

Alternate Treasurer / Mailing List Co-ordinator 2:James TekikoPrince of Wales HospitalJames.Tekiko@health.nsw.gov.au

Alterate Treasurer / Mail List Co-ordinator 3Rod AllenSt George Hospitalrodney.allen@ health.nsw.gov.au

Public Relations Officer:Emily EdmondsBlacktown HospitalEmily.Edmonds@health.nsw.gov.au

Alternate Public Relations Officer:Lynda GundryCentral Coast Local Health Districtlynda.gundry@health.nsw.gov.au

Newsletter Editor:Lee BeestonRoyal North Shore HospitalLee.Beeston@health.nsw.gov.au

Newsletter Assistant:Sandra TuttConcord Repatriation General HospitalSandra.tutt@sswahs.nsw.gov.au

Newsletter Assistant:Jacqui JensenSt Vincent’s Hospitaljacqueline.jensen@svha.org.au

Newsletter Assistant:Kathie BakerTamworth Rural Referral Hospitalkathleen.baker@hnehealth.nsw.gov.au

Committee Member:Amal HelouRoyal Prince Alfred Hospital amal.helou@sswahs.nsw.gov.au

Committee Member:David BeveridgeLismore HospitalDavid.Beveridge@ncahs.health.nsw.gov.au

Committee Member:Linda PopeLiverpool HospitalLinda.Pope@sswahs.nsw.gov.au

Committee Member:Nicole SmithHornsby HospitalNikki.Smith@health.nsw.gov.au

Committee Member:Donna ReevesDubbo Hospitaldonna.reeves@health.nsw.gov.au

Committee Member:Jane ElvyHunter Pain Clinicjanee@hunterpainclinic.com.au

Committee Member:Joshua Cohenjoshua.Cohen@sswahs.nsw.gov.au

PIG-NI NEWSPain Interest Group Nursing Issues

Newsletter July 2016

This edition

• PIGNI Chair

• National Ambassador

• Editor’s Message

• A Pioneer Retires

• Toula’s Story

• PIGNI 2016 AnnualProfessionalDevelopment Day

• PIGNI 2016 RuralScholarship

• A chat with ToulaKranitis

• The Middle Wife

• 2016 Committee

All correspondence tonewsletter editor:

Lee BeestonLee.Beeston@health.nsw.gov.au

Newsletter sponsored by

1

Sandra TuttChairperson, Pain Interest Group Nursing Issues

Half way through the year and has it not flown?

Have you registered for the October NSW PIGNI annualconference? This will be our 10th annual conferenceand we hope to see as many members and colleaguesthere. It promises to be a great day. Be an ambassadorfor pain management awareness in your hospital!

Are you aware that it’s National Pain Week 25th – 31stJuly, 2016? This is an annual event and more information can be found onwww.nationalpainweek.org.au

It may be too late to plan celebrations this year but think about planning fornext year.

Lee and the Newsletter team have put together an interesting collection ofarticles for you to read. They work hard to bring you this quarterlynewsletter. I hope you enjoy it.

I would like to thank, our sponsors of the NSW PIGNI newsletter, Hospira,now a Pfizer company, who have been sponsoring this newsletter for over 20 years and have been a great support to the PIGNI group.

Sandi

Dear Members,

As we endure a cold winter, be inspired today in our primary focus of thenewsletter, a heart-warming story from a pain a management nurse whoknows pain personally and professionally.

Toula Kranitis generously shares her experiences and by so doing,encourages us all to look to the heart of who we are and how we can best bean ambassador for pain management where we work, live and serve others.Toula has generously provided slides of the talk she gave staff at a healthcarefacility for people with disabilities which we may use.

Another great ambassador for pain management has retired! ProfessorMichael Cousins.

Editor’s Message April 2016

“I would like those suffering with chronic pain to know, I feel your pain andit’s ongoing. But, I now know it is all about learning as much as you can tomanage your pain as effectively as you possibly can.”

Chronic Pain Australia, National Pain Week (25 – 31 July 2016)promotes four core aims.

National Ambassador Michael Clarke

ICUMedicalconnectspatientsandcaregiversthroughsafe,life-saving,lifeenhancingmedicaldevices.

Weareoneoftheworld’sleadingpure-playinfusiontherapycompanies,withglobaloperationsandawide-rangingproductportfoliothatincludesIVsolutions,IVsmartpumps,dedicatedandnon-dedicatedIVsetsandneedle-freeconnectors,alongwithpainmanagementandsafetysoftwaretechnologydesignedtohelpmeetclinical,safetyandworkflowgoals.

Inaddition,wemanufactureautomatedpharmacyIVcompoundingsystemswithworkflowtechnology,closedsystemstransferdevicesforhazardousIVdrugs,andcardiacmonitoringsystemstooptimizepatientfluidlevels.

WiththeacquisitionoftheHospiraInfusionSystemsbusinessfromPfizerinFebruary2017,wearebuildinganentirelyneworganization—onethatiswhollyfocusedoninfusiontherapyandcommittedtodeliveringquality,innovation,andvaluetoourcustomersworldwide.