Multidisciplinary Team Standardizes Pain Management

MAYWOOD, Illinois—A 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.

Identifying Impediments

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 experience

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 nurses

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 standards.

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.