Matching Interventions to Barriers in Pain Management Ruth Cornish Program Manager.
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Transcript of Matching Interventions to Barriers in Pain Management Ruth Cornish Program Manager.
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Matching Interventions to Barriers in Pain Management
Ruth CornishProgram Manager
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National Institute of Clinical Studies
Role:
To improve health care by helping close important gaps betweenbest available evidence and
current clinical practice
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Whatwedo
Whatwe
know
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Acknowledgements
• Prof. Sanchia Aranda
• NICS advisors
• Deb Gordon & June Dahl (Wisconsin pain group)
• Pilot hospital teams
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Pilot hospitals
Royal Brisbane
Westmead
Newcastle Mater
Peter MacFlinders
Royal Adelaide
Royal Perth
Charles Gairdner
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Background
www.nicsl.com.au
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Aims1. 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
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Barriers - Institutional
• Lack of institutional commitment
• Poor visibility of the problem
• Professional territorial issues
• Unclear lines of responsibility
• Lack of practical tools & policies
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Barriers – Clinicians• Attitudes & beliefs of staff• No routine pain assessment• Under-estimation of patients’ pain• Analgesia misconceptions• Prescribing & administration inconsistencies• Inadequate knowledge and education
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Barriers – Patients
• Inevitability of pain
• Stoicism
• Analgesia fears & misconceptions
• Being a “good” patient
• Distracting from treatment
• Trade-offs: analgesics & side effects
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Where to start?
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Matchinginterventions to barriers
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• Lack of knowledge– Educational courses– Evidence based
guidelines– Decision aids
• Beliefs/Attitudes– Peer influence– Opinion leaders
• Lack of motivation– Incentives / sanctions
• Perception-reality mismatch– Audit & feedback– Reminders
• Systems of care– Process redesign
Generic Principle
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Institutional
• Lack of institutional commitment– Executive champions
– Peer hospitals?
• Poor visibility of the problem– Audit & feedback to executive
– We have a problem!
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Institutional
• Professional territorial issues– get everyone involved– multiple champions
Departments
Pain
Palliative care
Medical/Surgical
Quality/safety
Disciplines
Nursing
Medicine
Pharmacy
Quality/safety
eg.
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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
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Clinical
• Attitudes and beliefs–Opinion leaders
–Clinical champions
–Peers
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Clinical
• No routine assessment–documented pain scores on vital
sign chart
–reminders
–audit & feedback essential
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Clinical
• Prescribing inconsistencies–guidelines and decision aids at
point of prescribing–equi-analgesia cards–standardised prescribing
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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
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Patient
• Distracting from treatment–"your pain is important to us"–involve patient in their own pain
management –prompts to discussion
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Patient
• Analgesia fears, misconceptions (particularly addiction)–starting morphine is a "threatening
procedure" for cancer patients
–information for patients & families
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Matchinginterventions to barriers
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Begins with a sound analysis of barriers
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