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The initiative for pain management implemented at Duke University Health Systems in Durham, NC, a couple years ago has made all providers at the institution aware of the impact pain has on patients. It also helped staff identify the number of ways there are to control pain and resources to help the patients who are experiencing pain. As a result, they are able to get a better handle on pain control for their patients, says Linda E. Hood, RN, MSN, AOCN, an oncology clinical nurse specialist at the health care facility.
She has monitored the pain scores of cancer patients upon admission to the hospital to see how quickly the scores can be reduced to below a level of three or four on the pain scale and how many are discharged with levels of less than three or four. "To get people’s pain under control is really an important issue for our whole team," says Hood.
To lower pain scores, patients now learn why staff are asking them about pain and how they can best communicate the degree of pain they have. The institution uses the zero to 10 pain scale to help adults evaluate their level of pain and the faces scale for children, which pictures faces with expressions ranging from grimacing to smiling. The education is verbal and supported by written materials such as the patient pain guides published by the Agency for Healthcare Policy and Research based in Silver Spring, MD.
All patients receive a bill of rights for pain and cancer patients receive a special version adapted for cancer pain. In this document patients are told:
Staff also will discuss whether patients are satisfied with their pain relief. The bill of rights for pain covers the agents used to relieve pain and explains that there are specialized techniques for people who have unrelieved pain including nonpharmacological interventions. The education channel at the hospital broadcasts information on nonpharmacological pain relief methods such as progressive muscle relaxation and guided imagery, and patients often are given relaxation tapes to take home.
It’s important to teach patients that if pain can be kept under control they tend not to have as many complications, and that patients who don’t have their pain well controlled following surgery or some other medical incident can develop long-term chronic pain problems, says Hood. One of the mottoes selected when the pain initiative was launched is that healing doesn’t have to hurt. "Once you start talking about pain you have a big impact on helping relieve patients’ pain and improving their quality of life by helping them understand that it isn’t something they have to accept," she says.
With chronic pain, such as cancer pain, it is often changing patients’ mindset. They often put off taking their pain medications because they are afraid of becoming addicted, yet continual pain drains their energy and impacts their immune system, says Hood.
When the pain initiative was launched, all staff had to watch a videotape on pain and complete a self-learning packet. In addition, champions from each area of the hospital were selected to receive extra education about pain and its control. These champions were then available to provide support to staff, monitor the outcomes of patients, conduct in-depth pain assessments when necessary, and make referrals as indicated.
Champions now are recruited and trained annually, attend educational update sessions twice a year, and participate in monthly grand rounds on pain and palliative care. The pain initiative has been a re-educating process for both staff and patients, changing their perception of pain, says Hood.
For more information about the pain initiative at Duke University Health Systems, contact: