Making pain management education top priority

Hospice offers tips for stellar program

The Hospice of the Western Reserve of Cleveland makes pain management education a top priority, and the efforts have resulted in faster and more effective pain control for patients, officials say. “We can’t stress enough how important it is to make sure the staff is totally confident and totally on top of their assessment skills,” says Janice Scheuffler, PharmD, clinical pharmacist. “At all times, they are comfortable with what they’re assessing in the patient, and we get the best information on how the patient is experiencing pain, describing pain, and feeling pain,” she explains. “That drives the plan of care from pharmacological or nonpharmacological aspects.”

Education is crucial because a hospice has to be 100% confident in its staff’s assessment skills when it comes to pain management, she notes. For this reason, the hospice has a supportive educational program that emphasizes learning and clinical programs, inservices, and competencies for training and supporting staff, Scheuffler says.

Each new employee attends a pain management class, with nurses attending eight hours of pain treatment training that brings them to a baseline understanding of all aspects of pain management, including methadone use, she says. Also, there are clinicians who have greater training, including nurse practitioners, best practice nurses, pharmacists, and physicians who do home visits, Scheuffler adds.

All other hospice disciplines and hospice volunteers receive four hours of training in pain management, and this training includes information on documentation, team involvement, and assessment, Scheuffler says.

The hospice also has a core practice committee consisting of all members of a hospice team, including social workers, counselors, and others, and the pain subcommittee is part of that committee, says Bridget J. Montana, MS, APRN, MBA, chief operating officer.

Each month, the hospice holds education sessions at the team leader meetings about hot topics or new medications or controversial areas, reports Scheuffler. “The team leaders take that information, and it floats down to the team,” she notes. “We’re constantly looking at how you can get all the information out to such a large agency, and we feel this is a good way to do that.”

The hospice also sends educational information to ancillary providers, including pharmacies under contract with the hospice, Scheuffler adds. “We ask them to be part of our team; and if they are working with our nurses, then they should have the same information,” she explains.

Hospice nurses also are taught how to use their math skills to make the appropriate conversions between opioids and analgesics, Scheuffler says. “We often rotate and switch medicines for a variety of reasons, and we are strong in our feeling that nurses must have skills available to rotate patients from one drug to another, and that means math conversions to make sure the patient is handled appropriately,” Scheuffler says.

The pain management training is repeated on a regular basis for hospice nurses, says Mary Kay Tyler, MSN, CNP, pediatric nurse practitioner/team leader, and chair of the pain subcommittee. Nurses are given a critical thinking test with five or six scenarios of pain and symptom management, and they’re asked questions about these scenarios, such as what medications to use under certain conditions and how to do the conversions from one form to another, she reports. “We require an 80% pass rate on those tests,” Tyler says. “Anyone having difficulty with that needs to go back through the pain management class or have a one-on-one training session with a team leader or advance practice nurse.”

Now the hospice requires staff who have not taken the full day training course within the past two years to take it and the critical thinking test again, she says. “I think the staff really feel supported by these classes,” Tyler notes. “It might be anxiety-provoking to do yearly competencies, but I do think it’s evidence, at least for myself from being in an acute care setting, that they are being supported by the agency.”

This focus on education is part of the hospice’s culture of investing resources to promote certification and education of its staff, Montana notes. “A lot of times organizations focus on the new employee, and we’re very committed to evolving those clinicians,” she says. “But, we have an environment where the training takes staff to the next level, and it’s easier to do this because of our culture.”