MAYWOOD, IllinoisA multidisciplinary initiative at Loyola
University Medical Center has made significant strides toward achieving a
standardized approach to pain management.
Carol White, RN, MSN, AOCN, an advanced practice nurse in
cancer clinical services, described the initiative in a poster session at the
Oncology Nursing Society’s 26th Annual Congress.
After several committees over 5 years had initiated partial
plans, a new multidisciplinary committee was formed to complete a plan for an
institutional approach to pain management. Subcommittees were then formed from
each service line, with Ms. White as team leader of the cancer service group.
The primary desired outcome was to ensure that pain would be
assessed and documented for every patient across the continuum.
Team members first identified existing impediments to optimal
pain management. These included:
The subjective nature of pain
Myths about pain
Patient fears of addiction
Lack of accountability for documenting the patient’s pain
Lack of a standard pain assessment tool
Limited physician practice guidelines
Limited documentation tools
Lack of access to updated resources
Lack of formal pain management education for physicians and
To overcome these roadblocks and achieve the desired outcome, a
pain management program was implemented throughout the institution, in both
inpatient and outpatient areas. The goal of the program was to standardize the
overall approach to pain management and to ensure compliance with the Joint
Commission on the Accreditation of Healthcare Organizations (JCAHO) 2001 pain
Pain Information Fair
The multidisciplinary group placed pain scales in all inpatient
and outpatient areas, distributed reference books to 72 clinical areas, offered
pain lectures to clinical departments, added a pain lecture to RN orientation,
distributed a pain competency packet to all existing RNs, revised standing
orders for all epidural and patient-controlled analgesia (PCA) pain management,
and developed a neonatal pain scale.
The team used a variety of other activities to spread the word
about the importance of pain management. An institution-wide pain information
fair brought together 22 participants, including pharmaceutical representatives
and in-house pain experts, to disseminate pain information to approximately 250
employees. More than 125 people attended a luncheon talk on palliative care.
Patient’s Rights Statement
To achieve the institutional goal of making pain the
"Fifth Vital Sign," the group updated the patient’s rights
statement, added basic pain information to the patient handbook, and updated
nursing documentation forms.
Other important steps were the development of a standardized
pain assessment tool to be used in all practice settings, providing
consultation to several departments, and encouraging internal communication
about pain activity through newsletters.
Future goals include achieving a successful JCAHO survey,
identifying holistic approaches to managing pain, conducting ongoing physician
and nurse education, initiating house staff education and department lectures,
encouraging pain initiatives in all departments, reviewing pain management
progress, and exploring patient education opportunities.