IMPLEMENTING A PAIN RESOURCE NURSE PROGRAM Dr. Fran Hoh PhD APN PCM CS Current Research Improves Nurse Retention Improves Nurse Physician Collaboration Improves Patient Satisfaction Improves Nursing Autonomy Relevance to Your Organization Collect the Data How does pain management fit in with the hospital vision? What are your survey reports saying about pain? What kind of medication errors are you having? Relevance to Your Organization What is your Narcan use? Do you have patient complaints regarding inadequate pain management? Where there any issues regarding pain in your last JCAHO survey? Relevance to Your Organization Do you currently have a pain team? Do you have a physician pain champion? Do you have nursing administrators that are interested in pain management? De you have pain resources in your system? Do you have an out patient pain management program? Where did PRN begin? The City of Hope National Medical Center in California developed this program in the 90 s. Go the the website www.cityofhope.org and search pain resource nurse and you will get information on their program 1
Definition of PRN A Pain Resource Nurse is an RN who functions as both a resource and change agent in disseminating information, interfacing with nurses, physicians, other members of the health care team, patients and families to facilitate quality pain management. Financial Impact of a PRN program Cost to send nurses to the program Cost for nurses to do follow up projects Cost of speakers Cost of food, handouts, etc Clinical Ladder Program Obtaining Buy In Chief Nursing Officer Nurse Managers Nurses Physicians Developing Content What do other PRN programs do? How many days? Hospital Specific Content Clinical Issues In House vs. Paid Speakers Developing Content Policy/Procedure Non Clinical Issues Promoting Physicians/Programs Performance Improvement Educational Issues Cultural Issues Obtaining Funding Grant Department Pharmaceutical Companies Equipment Companies Association Grants 2
Selecting Pain Resource Nurses CRITERIA FOR SELECTION All shifts All Departments (some units more) 2 Years Experience Interest in Pain Management Commit to attend 6 meetings/year Selecting Pain Resource Nurses Demonstrates interest in sharing knowledge with staff through role modeling and teaching b. Demonstrates effective interpersonal skills, specifically the ability to collaborate with others c. Demonstrates commitment to own professional development through attendance at Pain Care Team monthly meetings d. Demonstrates knowledge and expertise in providing nursing care, problem solving, and implementing standards f. Demonstrates effective communication skills in written and verbal form Selecting Pain Resource Nurses APPLICATION PROCESS Signed Commitment Nurse and Manager Incentives for nurses Submit to Pain Coordinator After the Course Pass exam with 80% or better Develop 6mos and 12 mos goals-both unit and personal goals Sign up for subcommitte- Responsibilities of the Pain Care Team Chair Coordinates and facilitates the Pain Resource Nurse Training Program Collaborates with Nurse Manager and PRN regarding ongoing role development Coordinates monthly support and continuing education meetings Act as a resource for problem solving pain management issues Develops and implements ability based competency evaluation of PRN s Responsibilities of Nurse Manager Oversees the Pain Resource Nurse Collaborates with the PRN and Pain Care Team chair to develop plan to implement and evaluate the PRN role Provides support for the PRN to attend monthly meetings and operationalizing the role Participates in the evaluation of the PRN 3
Honoring Pain Resource Nurses Pins Certificates Poster Picture (used at Nurses Week, Mega Day, and other recognition events) CEU s Publicity- In House and Local Newspapers Utilization of PRN s 4 Subcommittees Education Policy/Procedure Clinical Practice Performance Improvement EDUCATION Presents monthly mega day Revise orientation self learning module for pain Develop unit based inservices Create article for hospital newletter Set up booths at Mega Day Performance Improvement Collects monthly pain audits 5 charts per unit Submit to Chairperson prior to meeting Chairperson presents at monthly Pain Committee meeting Reports results at monthly unit staff meeting Clinical Practice Narcan Chart Reviews Eliminating Demerol Trials for approaches to dermal pain with IV sticks Sickle Cell Protocol Questionnaire regarding EOL care TV education Depodur Education Policy/Procedure Develop Depodur policy Revise PCA policy Develop Ketamine policy Revise reassessment policy Work on special projects-pain Awareness Month 4
Difficulties Encountered Subcommittee meetings Committee meetings 6/year Coordinating many projects Getting projects completed Getting staff to utilize PRN s Impact on the Institution Improved Press Ganey Scores for Pain Improved Physician/Nurse Collaboration More aggressive pain Management Opened program up system wide Publicity for the hospital FUTURE GOALS Pain Management certification Create ELNEC program that includes pain resource nurses Run yearly PRN program QUESTIONS Contact Francine Hoh (908) 369-6823 Overlook Hospital Summit, NJ 07901 5
Responsibilities of the Pain Resource Nurse a. Assesses personal knowledge and attitudes as they relate to pain management b. Regular attendance at the Pain Care Team monthly meetings c. Acts as a role model for other staff by performing thorough pain assessments, documenting pain assessments, interventions and outcomes, communicating pain issues in reports and rounds, and teaching patients and families about pain management d. Performs informal needs assessment of clinical unit setting including a review of staff knowledge and attitudes about pain, general pain management practices and documentation to target areas for improvement e. Disseminates information about pain management through a variety of ways including coordination of unit inservices, journal article reviews, and dissemination of AHCPR/JCAHO guidelines f. Assists staff in calculating opiod dose and route equianalgesic calculations as necessary g. Facilitates pain quality assurance studies h. Attendance at the hospital wide pain committee meetings i. Identifies the need and assists in the development of pain management patient education materials and updates policies and procedures j. Collaborates with the Nurse Manager, Pain Care Team Chair, and other resource people as necessary to evaluate progress and to address any training issues k. Provides feedback to staff regarding pain management practices
Pain Resource Nurse Course Outcomes 1. Participants will improve knowledge about pain management as evidenced by an improved score on the post test. 2. Participants will feel more comfortable with management of pain as evidenced by improvement in comfort level as evidenced by a questionnaire at 6 months. 3. Positive Nurse Physician collaboration will develop with PRN s. 4. Course will be expanded next year to include system wide and outside participants. 5. Press Gayne scores will improve by 5 points by 3/07. 6. Demerol will only be used in restricted areas by 12/06. 7. Narcan will be used appropriately 75% of the time. 8. PRN nurses will coordinate pain awareness month by having educational programs for MD s, nurses, and the community. 9. Pain Education will increase to patients as evidenced by use and documentation of educational materials. 10. Pain Education to nurses will increase as evidenced by unit based pain management inservices, pain management video, pain management self learning modules. 11. Length of stay will decrease as a result of adequate pain management. 12. Pain management research will be presented at research day 2007. 13. PRN program will be advertised in local newspapers as well as nursing journals, and the overlook view. 14. Calls to pain nurse will increase from nurses to discuss plan of care for appropriate pain management. 15. Family complaints regarding pain management will be eliminated. 16. PCA use will increase as a modality to treat post op pain. 17. Qualitative data regarding pain management will improve. 18. PRN s will collaborate with the IS to ensure ease of pain documentation on computerized charting. 19. End of life care will improve by utilizing standardized order sheets and providing adequate symptom management in last days of life. 20. PRN s will teach pain content at Mega Day.