Without the Pain Resource Nurse Team at Paoli (Pa.) Hospital, a computer issue involving administration of pain medications still might be happening.
Some of the staff nurses noticed the three times a day administration of narcotics was not occurring at evenly spaced eight-hour intervals, but rather at a default of 9 a.m., 2 p.m. and 10 p.m., said Cynthia Wagner, RN-BC, MSN, CRNP, FNP-BC, ACHPN, palliative care and pain management coordinator at the hospital.
“Thats fine if its Maalox or something youre taking,” she said, “but not with a long-acting opioid.”
Instead of just changing the timing of doses for some patients, the team of 20 nurses investigated, pulling pharmacy data for the previous six months and discovering “it was a lot more common than anyone realized,” Wagner said.
The team asked physicians to show them how they ordered the medications in the computer system and discovered the root of the issue — the cumbersome system made choosing the right times confusing.
The team worked with the hospitals IT department for a couple of months to change the system, Wagner said. Now when doctors prescribe long-acting opioids, they choose from lists of evenly spaced eight-hour and 12-hour doses.
Along with improving patient safety and comfort, the nurses earned a system-wide Great Catch award recognizing them for their efforts. The team was proud to receive the award, but “we all kind of looked at it like it was our job,” said Margaret Jackson, RN-BC, BSN, CPAN, team member and a nurse in the hospitals post-anesthesia care unit.Rhonda Pierce, RN
Improving pain management
Thats just one of the ways the team has improved patient safety and satisfaction at the hospital. Another is through the continued and advanced education of the nurses.
When the team started in 2009, only Wagner was board certified in pain management, she said. Nurses from a variety of departments — including intensive care, emergency, obstetrics and trauma — joined because of their shared interest in pain management, Jackson added.
Now 16 nurses are pain management certified, and the team aims to have all of its nurses earn that certification.
During the teams meetings — which are held every other month — nurses take turns presenting education sessions to the group. Those who attend earn a contact hour, Wagner said. They also learn from community members such as hospice experts, music therapists, addiction specialists and even patients who speak with the group, Jackson said.
The team also reviews hospital pain policies. “Because the nurses are at the bedside, they see where improvement is needed,” Wagner said.Cynthia Wagner, RN
Providing expertise to fellow nurses
Through certification and team experiences, the nurses have become resources in pain management for other staff.
“These nurses are definitely looked at as experts on their units,” Wagner said.
Recently, on one of the hospitals surgical units, a nurse was working with a patient with end-stage cancer. The patient told the nurse she was not in pain but screamed when the nurse tried to turn her, indicating she did have pain, said Rhonda Pierce, RN-BC, MSN, CCRN, CHPN, an ICU nurse.
The patient, who had a brain tumor, couldnt speak about her pain but had shown that she needed the pain medication when she screamed, Pierce said. The situation became a learning opportunity for the nurse.
The team brings “individualized pain management” to their units. Because of their experiences, they understand that patients with the same diagnosis might not need the same pain medication if they are different ages, for example, Wagner said.
“One of the unique things about pain management is a cookie-cutter approach doesnt generally work,” she added.
Staff at the hospital call on that knowledge, which the team shares during a pain fair in September. The fair, which more than 150 clinicians attended in 2011, its first year, has booths that explain myths and facts about pain management, Wagner said.
“I definitely think its getting more and more recognized as a need,” she added.
Hospitals increased focus on patient satisfaction is part of what’s driving the push for pain management expertise, Wagner said. Pain-certified nurses improve patients pain and satisfaction with their care, she said.
“People are now cued in to assess better,” Jackson said. “Thats a great benefit to our patients.”
Karen Long is a freelance writer.