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Abstracts (1115) Pharmacist education in pain and palliative care: A report from the 2003 National Pain and Palliative Care Summit C. Herndon, J. Ray, P. Grauer, J. Dasta, C. Smith, K. Moore, T. Zaugg, V. Pai, D. Finnell; Ortho-McNeil Pharmaceutical, O‘Fallon, IL Institutions of pharmacy education have moved slowly to embrace the importance of pain and palliative care education in their didactic and experiential curricula. Despite pharmacists crucial role in the appropriate interdisciplinary management of pain and associated symptoms, a paucity of structured classes, modules, clerkships, and other postgraduate experiences continue to exist. Recently a National Pain and Palliative Medicine Summit was convened to bring together professionals interested in change in the education, provision, and policy surrounding pain and palliative care in the United States. Representatives from the professions of pharmacy, medicine, and nursing all provided current barriers and opportunities for improved education in the field of pain and palliative care in their respective professions. Pharmacists, and students of pharmacy, have numerous barriers to adequate education in the care of persons in need of pain and palliative medicine. Although recent research suggests a positive trend in the provision of this knowledge, much room for improvement still exists. Unfortunately, recent media attention has focused on several shortcomings in the attitude, skills, and knowledge of pharmacist with respect to pain and palliative care. To address these issues, and strategies for enacting change in the current pharmacy school curricula, pharmacists in two focus sessions identified initiatives necessary to begin a structured approach to changing the ways in which our pharmacists and students of pharmacy are introduced to pain and palliative medicine. These initiatives, identified as crucial by the pharmacy task force at the 2003 Pain and Palliative Care Summit, will be presented.
(1116) Focus on pediatric pain: the Advanced Clinical Practice Fellowship (ACPF) program: a collaboration between the Registered Nurses Association of Ontario, the University of Ottawa and the Children‘s Hospital of Eastern Ontario (CHEO) J. Ellis, B. Rowley, M. MacNeil; Children’s Hospital of Eastern Ontario, Ottawa, ON The Registered Nurses Association of Ontario (RNAO), through funding from the Ministry of Health and Long-Term Care (MOHLTC), developed an Advanced Clinical Practice Fellowship (ACPF) program for registered nurses to promote nursing knowledge and expertise and to improve client outcomes in Ontario. To date 164 ACPF fellowships have been funded and a number of them have focused on pain. ACPF fellows receive joint funding from RNAO and the sponsoring organization and dedicate 450 hours to the fellowship. This unique program enabled two nurses from the CHEO to step away from the bedside and focus their time and attention on learning about paediatric pain. Through the mentorship of a University of Ottawa, School of Nursing faculty member, both nurses developed ambitious learning plans that acted as a road map to help them reach their personal learning goals. In addition, both fellows contributed substantially to the work of the hospital with respect to improving pain assessment and management practices in the areas of acute and chronic pain. The power of this program is that it provides practicing nurses with an opportunity to suspend their practice and to focus on reading, thinking, writing and expanding their clinical skill set around a topic that is salient to their clinical practice. The organization benefits from nurses that are newly energized and can better advocate for a system that supports evidence-based best practices. Two initiatives that came from the fellowships include a pain resource nurse program and nursing representation on a multidisciplinary quality improvement team to develop a chronic pain service. In this presentation we will describe the ACPF program and its impact on both the nurses and the organization with respect to improved pain practices.
137 (1117) Pain assessment - present barriers and improvement strategies S. Gupta, K. Patel, D. Ressler; Einstein Pain Center, Albert Einstein Healthcare Network, Jefferson Health System, Philadelphia, PA Proper pain assessment is critical for an effective pain management. Unfortunately, there continues to be significant deficiencies in the assessment of pain. This study was performed to find out the extent of the problem , the barriers to proper pain assessment and the steps needed to improve the situation. Fifty randomly selected resident physicians from multiple specialties were surveyed in this study. They were asked if they are assessing pain routinely with 0-10 scale, the reasons for not assessing or documenting and also their suggestions for improvement. A majority of respondents stated that they do not assess pain routinely. The most frequent reasons given for under-assessment were 1. Forgetfulness 2. Not believing the patients - some said they thought patients were faking pain to stay hospitalized longer or to receive opioids. Suggestions for improvement included the following: Having preprinted progress notes, having the nurses record a pain score with the vitals; Positive and negative reinforcements, frequent reminders. In conclusion, the study reaffirms the need of improvement in pain assessment by physicians. The study suggests that disbelieving the patient can be a major contributor to not assessing and documenting the pain. Reminders like preprinted progress notes can be a useful way of improving pain assessment along with education and reinforcement.
(1118) Integrating an online case component into an interfaculty pain curriculum for six health professions R. Waterston, J. Hunter, L. Lax, J. Watt-Watson, L. Raman-Wilms, P. Pennefather, G. Regehr; University of Toronto, Toronto, ON The University of Toronto Centre for the Study of Pain has developed a unique interfaculty pain curriculum where students from 6 Health Professional Programmes learn together about pain assessment and management. Since 2002, this annual 20-hour curriculum consists of large group multi-professional sessions and small group inter-professional case-based learning. For the case-based component, students collaborate both face-to-face and online in small interprofessional groups to create a management plan for a case study. The goal was to investigate students evaluation of a mixed-mode case study that includes communicating online in their interprofessional groups. 565 students from six disciplines participated in March 2003. Of these, 46% (265) voluntarily completed an online survey at the end of the week about this interprofessional case-based learning experience. Students were asked to report on how communicating online contributed to their group process, the success of their case management plan, their appreciation of the knowledge of different health care professionals and their enjoyment of the mixed-mode experience. All evaluation components were approved by the University’s Human Subjects Ethics Review Committee. Factors that had a positive impact on student impressions included the extent to which group members participated equally in the online discussion, advance orientation to the programme, and the participation of their faculty facilitator in the online discussion. Online communication about a case study positively contributed to an interprofessional pain curriculum if certain design considerations are met. The findings from 2003 have been incorporated into the case for 2004. This iterative process will continue as we continue to improve this interprofessional pain curriculum.
(1116) Focus on pediatric pain: the Advanced Clinical Practice Fellowship (ACPF) program: a collaboration between the Registered Nurses Association of Ontario, the University of Ottawa and the Children‘s Hospital of Eastern Ontario (CHEO) J. Ellis, B. Rowley, M. MacNeil; Children’s Hospital of Eastern Ontario, Ottawa, ON The Registered Nurses Association of Ontario (RNAO), through funding from the Ministry of Health and Long-Term Care (MOHLTC), developed an Advanced Clinical Practice Fellowship (ACPF) program for registered nurses to promote nursing knowledge and expertise and to improve client outcomes in Ontario. To date 164 ACPF fellowships have been funded and a number of them have focused on pain. ACPF fellows receive joint funding from RNAO and the sponsoring organization and dedicate 450 hours to the fellowship. This unique program enabled two nurses from the CHEO to step away from the bedside and focus their time and attention on learning about paediatric pain. Through the mentorship of a University of Ottawa, School of Nursing faculty member, both nurses developed ambitious learning plans that acted as a road map to help them reach their personal learning goals. In addition, both fellows contributed substantially to the work of the hospital with respect to improving pain assessment and management practices in the areas of acute and chronic pain. The power of this program is that it provides practicing nurses with an opportunity to suspend their practice and to focus on reading, thinking, writing and expanding their clinical skill set around a topic that is salient to their clinical practice. The organization benefits from nurses that are newly energized and can better advocate for a system that supports evidence-based best practices. Two initiatives that came from the fellowships include a pain resource nurse program and nursing representation on a multidisciplinary quality improvement team to develop a chronic pain service. In this presentation we will describe the ACPF program and its impact on both the nurses and the organization with respect to improved pain practices.
137 (1117) Pain assessment - present barriers and improvement strategies S. Gupta, K. Patel, D. Ressler; Einstein Pain Center, Albert Einstein Healthcare Network, Jefferson Health System, Philadelphia, PA Proper pain assessment is critical for an effective pain management. Unfortunately, there continues to be significant deficiencies in the assessment of pain. This study was performed to find out the extent of the problem , the barriers to proper pain assessment and the steps needed to improve the situation. Fifty randomly selected resident physicians from multiple specialties were surveyed in this study. They were asked if they are assessing pain routinely with 0-10 scale, the reasons for not assessing or documenting and also their suggestions for improvement. A majority of respondents stated that they do not assess pain routinely. The most frequent reasons given for under-assessment were 1. Forgetfulness 2. Not believing the patients - some said they thought patients were faking pain to stay hospitalized longer or to receive opioids. Suggestions for improvement included the following: Having preprinted progress notes, having the nurses record a pain score with the vitals; Positive and negative reinforcements, frequent reminders. In conclusion, the study reaffirms the need of improvement in pain assessment by physicians. The study suggests that disbelieving the patient can be a major contributor to not assessing and documenting the pain. Reminders like preprinted progress notes can be a useful way of improving pain assessment along with education and reinforcement.
(1118) Integrating an online case component into an interfaculty pain curriculum for six health professions R. Waterston, J. Hunter, L. Lax, J. Watt-Watson, L. Raman-Wilms, P. Pennefather, G. Regehr; University of Toronto, Toronto, ON The University of Toronto Centre for the Study of Pain has developed a unique interfaculty pain curriculum where students from 6 Health Professional Programmes learn together about pain assessment and management. Since 2002, this annual 20-hour curriculum consists of large group multi-professional sessions and small group inter-professional case-based learning. For the case-based component, students collaborate both face-to-face and online in small interprofessional groups to create a management plan for a case study. The goal was to investigate students evaluation of a mixed-mode case study that includes communicating online in their interprofessional groups. 565 students from six disciplines participated in March 2003. Of these, 46% (265) voluntarily completed an online survey at the end of the week about this interprofessional case-based learning experience. Students were asked to report on how communicating online contributed to their group process, the success of their case management plan, their appreciation of the knowledge of different health care professionals and their enjoyment of the mixed-mode experience. All evaluation components were approved by the University’s Human Subjects Ethics Review Committee. Factors that had a positive impact on student impressions included the extent to which group members participated equally in the online discussion, advance orientation to the programme, and the participation of their faculty facilitator in the online discussion. Online communication about a case study positively contributed to an interprofessional pain curriculum if certain design considerations are met. The findings from 2003 have been incorporated into the case for 2004. This iterative process will continue as we continue to improve this interprofessional pain curriculum.