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To meet the standards on pain management of the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, many health care facilities are diligently working on initiatives. Most have found that the quickest way to achieve results is to create groups that are part of a larger committee to look at the various components of pain management.
While one committee at Children’s Hospitals and Clinics-Minneapolis was assembled to develop a comprehensive plan for pain management, several subgroups worked on all the issues in a parallel fashion. "It was an easier workload, and we did a lot quite quickly," says Casey Hooke, RN, MSN, APON, a clinical nurse specialist who worked on the education of patients and family about pain.
Other subgroups looked at pain assessment; reviewing the tools and their reliability and validity, and determining how the assessment would be documented; incorporating a statement about a patient’s right to pain management into the patient’s bill of rights; developing an institutional policy about pain; and creating a comprehensive staff education plan to introduce the new policy. Another group developed tools and a plan that can be adapted to each clinical area for measuring the quality of pain management.
Franciscan Skemp Healthcare is a large system with one major hospital, two rural hospitals, 13 clinics and numerous behavioral health centers, so a multidisciplinary committee was assembled to create a pain management plan. "We brought in people from the clinic setting, all the areas of the hospital, our nursing home, and subacute unit so we included the populations from birth to very old age," says Doris Doherty, BSN, RN, patient education coordinator. While the core group discussed the type of plan that the institution needed, the work was divided and assigned to subgroups.
As the group works on the pain initiative, staff education to increase awareness about pain management is being conducted. Two speakers have come to the institution to address interdisciplinary staff, and a conference has been held for physicians. A separate committee is working on a plan for staff education to be implemented once the initiative is complete.
Although there is a systemwide "pain team" at Clarian Health Partners in Indianapolis, currently the focus is on the evaluation of pediatric programs and materials for pain management, which is the patient group served by Riley Children’s Hospital. Once this work is complete, similar work will be done for the adult groups the other two hospitals in the system serve. "Our work will pave the way for what will need to be done for the remainder of our patients," says Cynthia Latty, BSN, RN, patient education coordinator/clinical educator at Riley Children’s Hospital.
To launch the project, a retreat was held for the Pediatric Pain Special Practice Group, and at that time, it looked at what programs and materials were currently in place for pain management. People from all three hospitals in the system participated in this brainstorming session. Areas focused on included staff education; patient education; supporting policies/philosophies/documents; services and departments involved, such as child life, pharmacy, anesthesia, home care and surgery; documentation forms and standards; and pain assessment tools.
"We divided up into respective groups to evaluate what already existed and what work needed to be done to fill the gaps we had determined. We have looked at what other institutions have done and what vendors have available," says Latty.