A Better Approach to Pain: Interdisciplinary Pain Committees Tahitia Timmons MSN, RN-BC, OCN Education Coordinator Jeff Sklar DC Chiropractic Services/ Director Eastern Region American Society for Pain Management Nursing Friday, September 9, 2016 Conflict of Interest Disclosure Authors Conflicts of Interest; T. Timmons, No Conflict of Interest. J. Sklar, No Conflict of Interest. Objectives Attendee will be able to define the term Interdisciplinary Pain Committee Attendee will be able to state the data on Interdisciplinary Pain Committees Attendee will be able to describe at least one method for establishing an interdisciplinary pain committee. Attendee will be able to state one threat to committee disengagement and ways to overcome that 1
Topic Importance Prevalence of pain among hospitalized patients 38% - 77% Joint Commission on Accreditation of Healthcare has focused on pain management since 1999 Source of dissatisfaction for patients and clinicians Uncontrolled/unmanaged pain impacts patients outcomes negatively Physically & psychologically Financial impact One report states pain costs about $560-$635 billion annually Reimbursement may be tied to management of pain Value based purchasing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Literature Review Quality Improvement Pain Measures: Introduction of Pain Specialty teams Review Policies and procedures Review tools Promotion of interdisciplinary/multidisciplinary care plans Staff education Patient education Audits for compliance Dedicating a clinical person to round for improvement (often referred to as a pain resource nurse) Creation of an interdisciplinary/multidisciplinary committee What the Literature Showed Raising awareness can be the first step in creating a dialogue Interdisciplinary versus multidisciplinary Multidisciplinary was usually physician focused Utilizing evidence based practice and interventions correlated with increased success Analyze for strengths and weakness 2
Literature Review Data driven Interdisciplinary programs/task forces/committees Increase service referral to complementary alternative medicine Increase HCAHPS pain domain score average between 6%- 28% (dependent on study) Increased staff response to awareness regarding the topic of pain management and assessment on post surveys May improve opioid management Pain Committees Pain Committees can be a way to create sustainability of goals No one strategy may be a perfect fit, committee should be tailored to the organizational need Value for the creation of interdisciplinary work is difficult to justify collecting data becomes important The work will be cyclical 2016 Rising Tide Our Impetus Cancer Treatment Centers of America (CTCA) at Eastern Regional Medical Center developed an Interdisciplinary Pain Committee in response to two factors: Statistical data received from HCAHPS surveys regarding the pain domain Patient population. 3
Our Background Late stage cancers tend to correlate with a greater prevalence of pain. Our population is composed mainly of patients with late stage cancers. Depending on stage and patient characteristics prevalence of pain in cancer patients may be as high as 86%. Our Journey to Creation Began as a nursing task force in response to patient needs Goal was to gather data and make recommendations Due to scope of task recommendation: establish an interdisciplinary pain committee Goal Increase Educational Pain Opportunities for Staff Creation of Interdisciplinary Committee Increase Awareness of Pain Management Options Increase Utilization of Services 4
Creating the Pain Committee Obtain buy in from leadership Create charter Determine what membership and composition looks like Recruit Understand what is within the scope of your committee and out of scope Composition Physicians Nursing Pain management Rehabilitation services, Chiropractic Services, Naturopath Mind Body Medicine (CAM) Pharmacy Leadership Case management Education Pastoral Quality Informatics Outpatient services *Adhoc members & guest speakers as needed After Implementation An improvement in Press Ganey top box percentile regional ranking for the HCAHPS question Staff Do Everything To Help With Pain from 74 in calendar year 2012 to 92 in calendar year 2013, a 24.32 percent increase. Positive results continued throughout calendar year 2014 with a 93rd percentile regional ranking. 5
Threats/Barriers Staff engagement Was the issue important to them Making it valuable Leadership engagement Consistency Scheduling Conflicting priorities What s the agenda? What is the focus? How do you not get derailed Stagnation Keeping Engagement Celebrate gains/focus on wins Share pertinent data Utilize expertise of members Have a strategy Long term & short term goals Recognize staff and appreciate the work 6
Plan for the Future Continue improving patient satisfaction and clinical outcomes regarding comfort, pain assessment, and pain management. Focus on research References American Pain Management Nurses http://aspmn.org/ City of Hope website http://prc.coh.org/ Cohen, M. Z., Easley, M. K., Ellis, C., Hughes, B., Ownby, K., Rashad, B. G.,... & Westbrooks, J. B. (2003). Cancer pain management and the JCAHO's pain standards: an institutional challenge. Journal of pain and symptom management, 25(6), 519-527. Dorflinger, L., Moore, B., Goulet, J., Becker, W., Heapy, A. A., Sellinger, J. J., & Kerns, R. D. (2014). A partnered approach to opioid management, guideline concordant care and the stepped care model of pain management. Journal of general internal medicine, 29(4), 870-876. Farahani, P. V., Alhani, F. and Mohammadi, E. (2013), Effect of establishing pain committee on the pain assessment skills of paediatric nurses. International Journal of Nursing Practice Franck, L. S., & Bruce, E. (2009). Putting pain assessment into practice: why is it so painful?. Pain Research & Management: The Journal of the Canadian Pain Society, 14(1), 13. Gatchel, R. J., McGeary, D. D., McGeary, C. A., & Lippe, B. (2014). Interdisciplinary chronic pain management: past, present, and future. American Psychologist, 69(2), 119. Glowacki, D. (2015). Effective pain management and improvements in patients outcomes and satisfaction. Critical care nurse, 35(3), 33-41. Grant M, Ferrell B, Hanson J, Sun V, Uman G. (2011) The enduring need for the pain resource nurse (PRN) training program. Journal of Cancer Education. 26:59 Haller, G., Agoritsas, T., Luthy, C., Piguet, V., Griesser, A. C., & Perneger, T. (2011). Collaborative quality improvement to manage pain in acute care hospitals. Pain medicine, 12(1), 138-147. Milton, J. (2013). Caring for patients with chronic pain: pearls and pitfalls. The Journal, 113(8), 620. Reich, D. L., Porter, C., Levin, M. A., Lin, H. M., Patel, K., Fallar, R.,... & Silverstein, J. H. (2013). Data-Driven Interdisciplinary Interventions to improve inpatient pain management. American Journal of Medical Quality, 28(3), 187-195. Silow-Carroll, S., Alteras, T., & Meyer, J. A. (2007). Hospital quality improvement: strategies and lessons from US hospitals. New York: The Commonwealth Fund. Turk, D. C., Stanos, S. P., Palermo, T. M., Paice, J. A., Jamison, R. N., Gordon, D. B.,... & Clark, M. E. (2010). Interdisciplinary pain management. Glenview, IL: American Pain Society. Smith, T., Temin, S., Alesi, E., Abernethy, A., Balboni, T., Basch, E., et, al (2012). American Society of Clinical Oncology Provisional Clinical Opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30(8), 880-887 Sterman, E., Gauker, S., & Krieger, J. (2003). A comprehensive approach to improving cancer pain management and patient satisfaction. In Oncology nursing forum (Vol. 30, No. 5, pp. 857-864). Oncology Nursing Society. Walrath, J. M., Muganlinskaya, N., Shepherd, M., Awad, M., Reuland, C., Makary, M. A., & Kravet, S. (2006). Interdisciplinary medical, nursing, and administrator education in practice: The Johns Hopkins experience. Academic Medicine, 81(8), 744-748. Thank You! 7