PAIN MANAGEMENT

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PAIN MANAGEMENT Powered By Docstoc
					 Matching Interventions to
Barriers in Pain Management

        Ruth Cornish
      Program Manager
National Institute of Clinical Studies

               Role:
   To improve health care by helping
     close important gaps between
       best available evidence and
         current clinical practice
What   What
 we     we
know    do
   Acknowledgements
• Prof. Sanchia Aranda
• NICS advisors
• Deb Gordon & June Dahl
  (Wisconsin pain group)
• Pilot hospital teams
              Pilot hospitals



                                   Royal Brisbane


Charles
Gairdner                           Newcastle Mater
                                    Westmead
Royal Perth          Flinders
               Royal Adelaide   Peter Mac
 Background

www.nicsl.com.au
                  Aims
1. To improve the identification of patients
   with pain
2. To improve the day-to-day management
   of pain for patients with cancer
3. To integrate effective cancer pain
   management into the core business of
   hospitals
      Barriers - Institutional
• Lack of institutional commitment
• Poor visibility of the problem
• Professional territorial issues
• Unclear lines of responsibility
• Lack of practical tools & policies
      Barriers – Clinicians
• Attitudes & beliefs of staff
• No routine pain assessment
• Under-estimation of patients’ pain
• Analgesia misconceptions
• Prescribing & administration
  inconsistencies
• Inadequate knowledge and
  education
         Barriers – Patients
•   Inevitability of pain
•   Stoicism
•   Analgesia fears & misconceptions
•   Being a “good” patient
•   Distracting from treatment
•   Trade-offs: analgesics & side effects
Where to start?
       Matching
interventions to barriers
            Generic Principle
• Lack of knowledge       • Lack of motivation
  – Educational courses     – Incentives / sanctions
  – Evidence based
    guidelines
                          • Perception-reality
                            mismatch
  – Decision aids
                            – Audit & feedback
• Beliefs/Attitudes         – Reminders
  – Peer influence
                          • Systems of care
  – Opinion leaders
                            – Process redesign
            Institutional
• Lack of institutional commitment
  – Executive champions
  – Peer hospitals?
• Poor visibility of the problem
  – Audit & feedback to executive
  – We have a problem!
                Institutional
• Professional territorial issues
  – get everyone involved
  – multiple champions

 eg.   Disciplines      Departments
       Nursing          Pain
       Medicine         Palliative care
       Pharmacy         Medical/Surgical
       Quality/safety   Quality/safety
                Clinical
• Inadequate knowledge, education
 – needs analyses useful
 – don’t expect attendance at special
   meetings
 – use existing meetings opportunistically
 – include in orientation, rounds, intranet
 – nursing competency standards
            Clinical

• Attitudes and beliefs
 –Opinion leaders
 –Clinical champions
 –Peers
            Clinical

• No routine assessment
 –documented pain scores on vital
  sign chart
 –reminders
 –audit & feedback essential
            Clinical
• Prescribing inconsistencies
 –guidelines and decision aids at
  point of prescribing
 –equi-analgesia cards
 –standardised prescribing
                 Patient
• Inevitability of pain; stoicism; being
  a "good" patient
  – "your pain is important to us"
  – organisation mission statement
  – hospital admission/discharge information
    includes pain management
  – ward posters
             Patient
• Distracting from treatment
 –"your pain is important to us"
 –involve patient in their own pain
  management
 –prompts to discussion
              Patient

• Analgesia fears, misconceptions
  (particularly addiction)
 –starting morphine is a "threatening
  procedure" for cancer patients
 –information for patients & families
       Matching
interventions to barriers
Begins with a sound
analysis of barriers

				
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