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

The LUHS Pain The LUHS Pain Management Resource Management Resource

Nurse TeamNurse Team

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