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Careful assessment and reassessment, timely administration, adequate doses, effective routes, and the correct medications are the tried and true components of successful pain management. When they needed to take their pain management beyond the basics, the nurses and physicians at St. Francis Hospital in Roslyn, N.Y., turned to what they learned in their palliative care program.

“We developed a dual performance improvement team to study the benefits that palliative care and pain management could deliver to both patients and physicians,” explains Susan Knoepffler, RN, MPA, CNA-NCC, Cardiac Catheterization Lab. Starting with a focus on palliative care, team members attended conferences and educational sessions and brought back what they learned to the hospital. “We educated staff on how to complete referrals and we worked with staff to provide quality symptom and pain control for our palliative care patients,” Knoepffler says.

With a palliative care program up and running, the team tackled their next challenge, focusing on pain. “We knew that we had to work on our assessment process, communication, and we knew that we had to start by educating our staff and our patients,” says Knoepffler. Patient participation is encouraged with new pain brochures. “We have refined our pain management booklet,” explains Knoepffler, “and we it them available throughout the inpatient and outpatient settings.” The booklet emphasizes the importance of good communication and reminds patients that their active participation is key. The booklet describes assessment tools, types of pain control and types of pain, as well as what patients can expect. A thorough pain management survey is also given to patients at discharge (see Sidebar).

“We want to know not only how well we are doing, but also where we need improvement,” says Cheryl Cohen, RN, BS, MS, performance improvement specialist. The goal for the pain program is to achieve a Press-Ganey score of 90% or greater.
A key piece of the new pain program at St. Francis was the educational pain management symposium held this past September. “One year earlier, Daniel Sajewski, MD, and I attended a pain conference and met with the keynote speaker,” explains Lynn Grimaldi, RN, Cardiac Fitness and Pain Management. “We talked with him about planning a conference at St. Francis for the following year.”

Sr. Katherine A. Murphy, RN-BC, MSN, CHPN, PCCN, clinical nurse specialist, and Grimaldi worked to find grants for funding and planned a program that featured physicians and nurses who spoke on all aspects of pain management, including pathophysiology of pain, pain assessment, integrative approaches, chiropractic medicine, opioids, and aberrant drug-taking behaviors. With more than 200 attendees, the symposium was well received and the team is planning to make it an annual event.

As a result of this journey, the nurses on the pain management team have new insights into pain management (sidebar). “We know that we need to talk realistically about pain and we may not be able to reach 100% relief,” says Knoepffler, “so we need to ask patients what is acceptable, what is a realistic goal?”

The team is also working on answering consults on a timelier basis. “Right now we allow 24 hours from the time that the referral is made,” says Murphy. “We are working on how we can get to these patients sooner.”

And working together with Performance Improvement, the team is learning how to accurately measure the success of the program. “The PI Department keeps us on track,” says Knoepffler. “Having measurable goals is essential.”

“We knew that this was something we had to address, and our work in palliative care helped us zero in on the patient's perception of pain,” says Murphy.
"We've learned that when the patient reports that he or she feels fine, but is unable to participate in physical therapy, we are not optimizing our pain management. We learned that we needed to be more accurate and more specific in our approach to pain management.”

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Carol Dunbar, APRN, is a contributing writer for Nursing Spectrum.
To comment, e-mail editorNY@nursingspectrum.com.

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