Implementation of Pain Resource Nurse

Transcription

1 Implementation of Pain Resource Nurse SARAH MERKLE RN, MSN, OCN September 17, 2012 Objectives Explain the background which elicited the development of the 2-North Pain Resource Nurse Team (PRN) Describe the roles of the Pain Resource Nurse Discuss methods implemented Describe evaluation method Presentation of results Disseminate the knowledge acquired through the development and implementation of the 2-North Pain Resource Nurse Team Page 1

2 Presbyterian Intercommunity Hospital Presbyterian Intercommunity Hospital 444-Bed, not-for-profit regional medical center Serving nearly one million people in Los Angeles and Orange Counties STEMI Receiving Center/Stroke Center Regional Disaster Center Home Health and Hospice Services Comprehensive Cancer Center Page 2

3 Background Knowledge deficit identified o Documented practices out of policy o Verbalization of misconceptions regarding pain management. Over 60% of patients receiving cancer treatment experience pain to a certain degree Severe uncontrolled pain is one of the most feared consequences of cancer Initial NRC Picker scores reflected 76.4% of our patients were reporting that they felt we were doing everything we could to help control their pain. Background Value Based Purchasing: Pay-for-Performance CMS final ruling April Measures for VBP calculation 12 clinical measures Patient experience 8 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey dimensions (including pain management) Page 3

4 Methods The aim was to increase the unit s patient satisfaction results to exceed 87.2%. Used Plan, Do, Check, Act model (PDCA) Conducted literature review Utilization of Pain Resource Nurse (PRN) model 2 nurses attended PRN training at City of Hope Developed an educational program to disseminate knowledge National Comprehensive Cancer Center Network (NCCN) guidelines for pain management Methods The goal is to have at least one PRN nurse scheduled per shift. Utilizing the current recommendations for practice, the team developed an evidenced based comprehensive pain assessment tool Document when next dose is due on white board in patient room Implementation of PRN model hospital wide Discharge phone calls Page 4

5 Roles of the Pain Resource Nurse 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 Complete at least 2 comprehensive pain assessments every shift Utilizes daily rounds to identify patients in need of comprehensive pain assessment Evaluation Development of a focus group to support the role of the Pain Resource Nurse Case studies Review NRC Picker data Evaluate PDCA cycle PRN Tracking Board located on 2-North Focus population expanded to any patient receiving PRN pain medication Uncontrolled pain Plans for discharge Increase in consultations to Pain Education Nurse Sue Jervik BSN, RN-BC Page 5

6 Evaluation Some of the challenges the PRN faced thus far include: Personal insecurities about approaching physicians with recommendations Fitting the activities into busy workdays Sustainability of the role HCAHPS Dimension Page 6

7 Pain Questions Pain Questions Page 7

8 Discussion What was the key to our success? Physicians were not originally identified as stakeholders Implementation of PRN hospital wide Future plans include the re-implementation of discharge phone calls Thank you Questions? Page 8

9 References Cope, D. (2008). An Evidenced-Based Approach to the Treatment and Care of the Older Adult with Cancer. Pittsburg: Oncology Nursing Society Dalton, J., Bernard, S., Blau, W., ( 1995). Managing cancer pain: Content and scope of an educational program for nurses who work in prodominity rural areas. Journal of Pain and Symptom Management 10 (3) Idell, C., Grant, M., & Kirk, C. (2007). Alignment of pain reassessment practices and national comprehensive cancer network guidelines. Oncology Nursing Forum, 34(3), Retrieved October 30, 2011 from CINAHL database. Edwards,E. H, Nash, E. R. Patsy, Yates, M., et. al (2001) Improving Pain Management by nurses: A pilot peer program. Nursing and Health Sciences 3 (1) Ferrell, B., Grant, M., Padilla, G. (1991). Experience of pain and perceptions of quality of life: Validation of a conceptual model. Hospice Journal 7(3) 9-24 McCleary, L., Ellis, J., Rowley, B. (2004) Evaluation of the Pain Resource Nurse Role: A Resource for Improving Pediatric Pain Management. Pain Management Nursing 5(1). Sterman, E., Gauker, S., & Krieger, J. (2003). A comprehensive approach to improving cancer pain management and patient satisfaction. Oncology Nursing Forum, 30(5), Retrieved October 28, 2007 from CINAHL database. Woodward, D. (2005). Developing a pain management program through continuous improvement strategies. Journal of Nursing Care Quality, 20(3), Retrieved October 10, 2011 from CINAHL database. Page 9