OBJECTIVES 5NW GERIATRICS UNIT. nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

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1 Family Education for Nonverbal Patient Pain Control Jeannette (Jeannie) Meyer, MSN, RN, CCRN CCNS, PCCN, ACHPN Clinical Nurse Specialist Palliative Care Santa Monica UCLA Medical Center Anila Ladak, RN, MSN, CNS, GNP-BC Clinical Nurse Specialist, Geriatrics Santa Monica UCLA Medical Center Suzanne P. Graf, RN, BSN, PHN Mount Saint Mary's University Adult-Gerontology Clinical Nurse Specialist student Valerie Yeo, RN, MSN, NE-BC Unit Director, Geriatrics Santa Monica UCLA Medical Center 1 OBJECTIVES At the conclusion of this presentation, the active learner will be able to: Recognize the targeted population for project Understand gap between pain domain HCAHPS scores from 5NW as compared to the UHC Discuss pain control barriers reported by 5NW staff Review proposed educational intervention plan for 5NW 2 5NW GERIATRICS UNIT A Unique Patient Population Criteria for Admission: Age 65 + Primary MD is a Geriatrician Typical Presentations: Dementia Non-ambulatory Nonverbal End-of-Life 3 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

2 HCAHPS QUESTIONS/ 5NW SCORES During this hospital stay, how often was your pain well controlled? Always 5NW = 45% versus UHC = 63% During this hospital stay, how often did the hospital staff do everything they could to help you with your pain Always 5NW = 65% versus UHC = 77.4% (UHC = University Healthsystem Consortium) 4 BARRIERS TO PAIN CONTROL What does the literature say? American Pain Society position statement American Geriatric Society clinical guidelines What did our 5NW nurses say? Pain Barriers Project Survey (4-5/2015) Top Three Barriers Physician Orders 63% Patient/Family Issues 63% Patient/Family Expectations 75% 5 5NW % % 63% 4 38% 38% 3 25% 25% 25% 5NW 2 13% 13% 1 6 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 2

3 EBP FOCUS PDCA 7 EBP FOCUS PDCA The Plan RN Guidelines for Family Education Behavioral Pain Assessment Presumptive Pain Indicators Around the Clock Pain Medication Educational Handout for Families Sixth Grade Reading Level Topics Coincide with RN Guidelines 8 PAIN-AD TOOL Items SCORE Breathing Independent of vocalization Negative vocalization Normal None Occasional labored breathing. Short period of hyperventilation Occasional moan or groan. Low-level of speech with a negative or disapproving quality. Noisy labored breathing. Long period of hyperventilation. Cheyne-stokes respirations. Repeated troubled calling out. Loud moaning or groaning. Crying. Facial Expression Smiling or inexpressive Sad, frightened, frown. Body Language Relaxed Tense. Distressed pacing. Fidgeting. Facial grimacing. Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out. Consolibility No need to console Distracted or reassured by voice or touch. Unable to console, distract, or reassure. (Warden, Hurley, & Volicer, 2003) Total 9 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 3

4 PRESUMPTIVE PAIN INDICATORS Pre-existing conditions Fractures Pressure Ulcer(s) Contractures Surgery 10 AROUND THE CLOCK PAIN MEDICATIONS Rational for Use For continuous pain Long-acting medication(s) scheduled with shortacting medication(s) for breakthrough pain Evidence Based Practice Share with our Families the Why 11 EDUCATIONAL MATERIALS & GOAL Review of Proposed Materials Guidelines for Nurses Educational Handout for Families The Goal Future HCAHPS Score Improvement Consistent Performance Comparable to UHC 12 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 4

5 Geriatric Pain Assessment Algorithm 13 Results of 5NW surveys. Bedside RN find the guidelines helpful 10 Family allowed ATC administration of pain medication after educational Intervention 4 Family expressed their perception that patient s pain was well controlled 6 14 HCAHPS SCORES FOR 5NW Question July-Sept 2015 Oct-Dec 2015 During this hospital stay, how often was your pain well controlled? 52.6% 73.3% During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? 78.9% 66.7% 15 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 5

6 QUESTIONS/COMMENTS 16 REFERENCES AGS Panel on Pharmacological Management of Persistent Pain in Older Persons. (2009). Pharmacological management of persistent pain in older persons. Journal of American Geriatrics Society, 57, doi: /j x American Pain Society 6th Edition Panel. (2008). Principles of analgesic use in the treatment of acute pain and cancer pain (6th ed.). Glenview, IL: American Pain Society. 17 REFERENCES Herr, K., Coyne, P. J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Management Nursing, 12(4), doi:doi: /j.pmn Warden, V., Hurley, A.C., & Volicer, V. (2003). Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. Journal of Medical Directors Association, 4(1), nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 6