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Managing a Difficult Day for Patients with Chronic Pain
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Meeting Abstracts
Improving Patient Safety for Patients on Opioid Medications: Revising the Verification Process Lynn Anson, RN-BC Children’s Mercy Hospital and Clinics, Kansas City, MO Kathlyn Babareen, RN, BSN, CCRN; Elizabeth Edmundson, RN; Michele Fix, RN, BSN; Jenny Marsh, RN, BSN, CPON; Holly McFarland, RN; Kelly O’Neill, RN, BSN, CPON; Janis Smith, RN, DNP; Janet Sollazzo, RN, BSN, CPN; Carrie Tiner, RN, BSN, CPN The need for medication safety is paramount for all patients, especially those prescribed opioids in the pediatric population. Electronic documentation can play a substantial role in safe administration practices; however, caution must be taken to assure that the clinical practice components essential to safety are not lost in the transition. One Midwestern pediatric hospital recently implemented a new electronic documentation system. By design, two registered nurse signatures were required for opioid waste verification, as was previous practice. However, two signatures for verifying dosages and pump programming, which also were previously required, were no longer necessary. Although two RNs were still needed to verify dosages and programming, many nurses misunderstood this lack of signature requirement as no need for a verification check at all. Using patient-controlled analgesia (PCA) incident reports, the institution’s PCA Task Force identified that most PCA errors could have been prevented with proper verification by two RNs. In August 2008, a subcommittee of the institution’s Nursing Practice Council, consisting of pain management nurses, direct care nurses, nurse educators, and administrative representatives, examined the current process and formulated an improved verification process for PCA/epidural infusions and high-risk medication administration. No longer an independent double check, verification now involves each nurse verbalizing either the orders or pump components to each other in a designated sequence to reduce reading errors. This process occurs at every shift change, transfer of care, initiation of PCA/epidural infusions, medication, and concentration changes, bolus dosing, and high-risk PO/IV medication administration. An educational plan was developed and implemented to disseminate this new information, including videos, live demonstrations, laminated instruction cards, e-mails, newsletters, and web-based testing. An auditing process was developed to determine its effectiveness, nursing compliance, and the need for further education that is currently ongoing. Since implementation, nurses state a better understanding of the verification process. Development of a Quality Improvement Process after Evaluation of Patient Outcomes and Nursing Documentation Maryjane Cerrone, MSN, RN-BC Lehigh Valley Health Network, Allentown, PA Kathy Fenstermaker The release of the new opioid treatment guidelines in February 2009 and the implementation of the Risk Evaluation Mitigation Strategies prompted the development of a compliance quality improvement project. Within clinical practice, there are many
patient issues that can arise with opioid prescriptions. To ensure patient safety and good practice, a compliance monitoring system or program has been developed. Many patient telephone calls, lost prescriptions, inappropriate use of the medication, and other concerns are dealt with on a daily basis. A pilot program was developed, and 200 charts were reviewed for patient teaching. The next step was to develop a onepage education sheet and implement a follow-up telephone call to the patient after a prescription was given. The educational tool and telephone call procedure was to be implemented January 11, 2010. A comparison of the data will be made 3 months after implementation. The outcomes include: the number of telephone calls from patients, lost prescriptions, compliance in taking the medication as directed, and any other concerns that may come up. In conjunction with this, charts will be reviewed for documentation of the elements of the Universal Precautions for Pain Management. Outcomes will be reported as well as process improvements within the outpatient setting. These results will be shared and guidelines implemented within the Lehigh Valley Health Network physician outpatient offices.
Managing a Difficult Day for Patients with Chronic Pain Andrea Eickhoff, RN Mayo Clinic, Rochester, MN Peg Dokken, RN; Kristy Zeitler, RN Managing a patient with chronic pain can be challenging. Many of these patients are missing work or are out of work, going to the emergency room because of flares of their chronic pain, and have a high utilization of health care resources. These patients have exhausted most treatment options. The Pain Rehabilitation Center (PRC) is an intensive outpatient program focusing on functional restoration and improving quality of life for patients with chronic pain. The program consists of a multidisciplinary team of pain specialists who guide therapy in physical reconditioning, relaxation training, stress management, chemical health education, and activity moderation. Cognitive behavioral therapy to decrease the sense of catastrophic pain and anxiety related to pain is also used. Difficult day planning is an important concept that the patients learn while attending the 3-week program. What is a difficult day? Patients describe these days as involving increased pain, fatigue, and fear of incapacitating symptoms. When a flare occurs, it can be hard to cope. This presentation shows an example of a typical patient’s difficult day plan, highlighting specific coping strategies used to manage their increased symptoms.
Comparison of PCEA and CEA in Minimally Invasive Surgical Total Knee Arthroplasty Patients Denise A. Fasolis, RN-BC Washington Hospital Healthcare System, Fremont, CA Cathy Warner, RN, MN, OCNS-C; Brian Smith, MD; Alisa Curry, PT, DPT; Martha Kennedy, RN-PACU; Laurie Miller, RN-PACU
Pain Management Nursing, Vol 12, No 2 (June), 2011: pp e1-e11
Meeting Abstracts
Improving Patient Safety for Patients on Opioid Medications: Revising the Verification Process Lynn Anson, RN-BC Children’s Mercy Hospital and Clinics, Kansas City, MO Kathlyn Babareen, RN, BSN, CCRN; Elizabeth Edmundson, RN; Michele Fix, RN, BSN; Jenny Marsh, RN, BSN, CPON; Holly McFarland, RN; Kelly O’Neill, RN, BSN, CPON; Janis Smith, RN, DNP; Janet Sollazzo, RN, BSN, CPN; Carrie Tiner, RN, BSN, CPN The need for medication safety is paramount for all patients, especially those prescribed opioids in the pediatric population. Electronic documentation can play a substantial role in safe administration practices; however, caution must be taken to assure that the clinical practice components essential to safety are not lost in the transition. One Midwestern pediatric hospital recently implemented a new electronic documentation system. By design, two registered nurse signatures were required for opioid waste verification, as was previous practice. However, two signatures for verifying dosages and pump programming, which also were previously required, were no longer necessary. Although two RNs were still needed to verify dosages and programming, many nurses misunderstood this lack of signature requirement as no need for a verification check at all. Using patient-controlled analgesia (PCA) incident reports, the institution’s PCA Task Force identified that most PCA errors could have been prevented with proper verification by two RNs. In August 2008, a subcommittee of the institution’s Nursing Practice Council, consisting of pain management nurses, direct care nurses, nurse educators, and administrative representatives, examined the current process and formulated an improved verification process for PCA/epidural infusions and high-risk medication administration. No longer an independent double check, verification now involves each nurse verbalizing either the orders or pump components to each other in a designated sequence to reduce reading errors. This process occurs at every shift change, transfer of care, initiation of PCA/epidural infusions, medication, and concentration changes, bolus dosing, and high-risk PO/IV medication administration. An educational plan was developed and implemented to disseminate this new information, including videos, live demonstrations, laminated instruction cards, e-mails, newsletters, and web-based testing. An auditing process was developed to determine its effectiveness, nursing compliance, and the need for further education that is currently ongoing. Since implementation, nurses state a better understanding of the verification process. Development of a Quality Improvement Process after Evaluation of Patient Outcomes and Nursing Documentation Maryjane Cerrone, MSN, RN-BC Lehigh Valley Health Network, Allentown, PA Kathy Fenstermaker The release of the new opioid treatment guidelines in February 2009 and the implementation of the Risk Evaluation Mitigation Strategies prompted the development of a compliance quality improvement project. Within clinical practice, there are many
patient issues that can arise with opioid prescriptions. To ensure patient safety and good practice, a compliance monitoring system or program has been developed. Many patient telephone calls, lost prescriptions, inappropriate use of the medication, and other concerns are dealt with on a daily basis. A pilot program was developed, and 200 charts were reviewed for patient teaching. The next step was to develop a onepage education sheet and implement a follow-up telephone call to the patient after a prescription was given. The educational tool and telephone call procedure was to be implemented January 11, 2010. A comparison of the data will be made 3 months after implementation. The outcomes include: the number of telephone calls from patients, lost prescriptions, compliance in taking the medication as directed, and any other concerns that may come up. In conjunction with this, charts will be reviewed for documentation of the elements of the Universal Precautions for Pain Management. Outcomes will be reported as well as process improvements within the outpatient setting. These results will be shared and guidelines implemented within the Lehigh Valley Health Network physician outpatient offices.
Managing a Difficult Day for Patients with Chronic Pain Andrea Eickhoff, RN Mayo Clinic, Rochester, MN Peg Dokken, RN; Kristy Zeitler, RN Managing a patient with chronic pain can be challenging. Many of these patients are missing work or are out of work, going to the emergency room because of flares of their chronic pain, and have a high utilization of health care resources. These patients have exhausted most treatment options. The Pain Rehabilitation Center (PRC) is an intensive outpatient program focusing on functional restoration and improving quality of life for patients with chronic pain. The program consists of a multidisciplinary team of pain specialists who guide therapy in physical reconditioning, relaxation training, stress management, chemical health education, and activity moderation. Cognitive behavioral therapy to decrease the sense of catastrophic pain and anxiety related to pain is also used. Difficult day planning is an important concept that the patients learn while attending the 3-week program. What is a difficult day? Patients describe these days as involving increased pain, fatigue, and fear of incapacitating symptoms. When a flare occurs, it can be hard to cope. This presentation shows an example of a typical patient’s difficult day plan, highlighting specific coping strategies used to manage their increased symptoms.
Comparison of PCEA and CEA in Minimally Invasive Surgical Total Knee Arthroplasty Patients Denise A. Fasolis, RN-BC Washington Hospital Healthcare System, Fremont, CA Cathy Warner, RN, MN, OCNS-C; Brian Smith, MD; Alisa Curry, PT, DPT; Martha Kennedy, RN-PACU; Laurie Miller, RN-PACU
Pain Management Nursing, Vol 12, No 2 (June), 2011: pp e1-e11