Вы находитесь на странице: 1из 28

The team

The team Meghan Callahan Tyler Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon
The team Meghan Callahan Tyler Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon
The team Meghan Callahan Tyler Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon
The team Meghan Callahan Tyler Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon

Meghan Callahan Tyler Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman

Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Dunker Keelie Gallagher Sandrine Loko Jonathan Martens Alyssa McCormick Emma McMahon Kimberly Wallace Julie Zuckerman
Introduction Skipa Martens
Introduction Skipa Martens
Introduction Skipa Martens

Introduction

Skipa Martens

Introduction:

Pain! What is pain?

Acute Pain versus Chronic pain?

Pain management among hospitalized patients has remained the optimal concern for healthcare providers, especially for those within the ICU setting, involving personal and ethical views.

63-74% hospitalized patients, within the United States alone, mentioned that their pain was managed poorly, including those patients who were sedated, intubated, and in the intensive care units.

Pharmacologic versus Non-Pharmacologic interventions?

Our focus and the significance for nurses.

(Centers for Medicare & Medicaid Services, 2011) & (Centers for Disease Control and Prevention, 2012)

Clinical Question Skipa Martens
Clinical Question Skipa Martens
Clinical Question Skipa Martens

Clinical Question

Skipa Martens

Clinical Question (Best Practice):

Is the use of non-pharmacological interventions more effective in reducing acute pain than the use of traditional pharmacological interventions in adult high acuity patients during their hospitalization?

P: adult high acuity patients

I: non-pharmacological interventions (music, massage, touch, guided imagery, hypnosis, etc)

C: pharmacological interventions (opioids, and non-opioids)

O: reduce acute pain

T: duration of hospitalization

Implementation: decrease pharm cost, increase nurse patient relationship, increase patient satisfaction without risk of dependency/addiction to pain meds

Current Practice Emma McMahon
Current Practice Emma McMahon
Current Practice Emma McMahon

Current Practice

Emma McMahon

Current Practice: Emma McMahon

According to the article Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium in Adult Patients in the Intensive Care Unit

● Standardized pain assessment scales

○ Behavioral pain scale and critical care pain observational tool

○ Vital signs used as cue for further assessment of pain

(Barr et al., 2013)

● Pain Management

○ For invasive or potentially painful procedures preemptive analgesia therapy and nonpharmacologic interventions such as relaxation should be used.

○ IV opioids should be considered as first line drug class of choice to treat non-neuropathic pain in critically ill patients

○ Nonopioid analgesics should be used to decrease the amount of opioids administered and to decrease opioid related side effects

○ Gabapentin or carbamazepine be used in addition to IV opioids for neuropathic pain

(Barr et al., 2013)

Current Literature Sandrine Loko
Current Literature Sandrine Loko
Current Literature Sandrine Loko

Current Literature

Sandrine Loko

Synopsis of Current Research Findings for pharmacological Interventions:

- One research suggested that IV morphine, IV fentanyl, and IV promethazine relieved up 80% of cardiac pain in 93% of the control group of elders in the postop stage (Sattari, Baghdadchi, Kheyri, Khakzadi & Mashayekhi, 2013).

- The most used opioid analgesics in the ICU include hydrocodone/tylenol, oxycodone, oxycodone/paracetamol, codeine/paracetamol, methadone, fentanyl, morphine and oxymorphone (Smith & Bruckenthal, 2011).

- Another research suggested that while many nonpharmacological interventions can potentially be useful for pain management in the ICU, they should remain complementary to pharmacological treatment until additional empirical evidence supports their effectiveness for pain relief (Gelinas, Arbour, Michaud, Robar, & Cote, 2013).

- As of now, there are no other specific therapies that could replace opioids and effectively control pain in the ICU patients (Erstad & Puntillo, 2013).

- In the ICU patients, opioids is recommended as the first line therapy for pain management (Diallo & Kautz, 2014).

 

Synopsis of Current Research Findings for non pharmacological Interventions:

 
 

The most common non pharmacological therapy was music.

 

.

.

Spontaneous harp music, preferred music, natural wave sounds significantly reduce pain perception.

Preferred music reduced pain intensity by three to four time from the baseline (Jafari, Zeydi, Khani, Esmaeili, & Soleimani, 2012 ).

.

.

Hand massage significantly relieved pain intensity (Martorella, Michaud, & Gelinas, 2014).

.

20 minutes of cold application prior to chest tube removal significantly pain level (Ertuğ & Ülker,

2012).

 

. Nurses suggested using nonpharmacological interventions as complementary to pharmacological treatments for pain.

 
Strengths and Limitations Tyler Dunker
Strengths and Limitations Tyler Dunker
Strengths and Limitations Tyler Dunker

Strengths and Limitations

Tyler Dunker

Strengths and Limitations: Tyler Dunker

Harp, Cool temperature, Music, Hand massage, Lavender

Strengths:

High statistical power/Confidence (Accurate) Mutli-modal data collection (Extensiveness) Randomized control trial (3/ Golden standard) Highly selective population (Inclusion criteria) Long times of data collection (Over a year in

Limitations:

Small sample sizes (Largest = 140) Limited setting (Limited technologically) Barriers present (Noise, multiple clinical interventions, family presence, ect.) Convenience sampling (2 studies) Disqualification (Patient unresponsiveness)

two studies, decreases external factors)

unresponsiveness) two studies, decreases external factors) Table of evidence or 9 related articles on reference page.

Table of evidence or 9 related articles on reference page.

EB Nursing Recommendations Julie Zuckerman
EB Nursing Recommendations Julie Zuckerman
EB Nursing Recommendations Julie Zuckerman

EB Nursing Recommendations

Julie Zuckerman

EB Nursing Recommendations: Julie Zuckerman

Best Practice:

● Pharmacological measures are more effective for pain compared with non-pharmacological interventions.

○ This can be applied when pain is above a tolerable level for the patient.

○ If the pain is at a below tolerable level, non-pharmacological measures are appropriate to cover for the smaller effectiveness of pain coverage.

Recommendations:

● Start with obtaining vital signs to assess patient’s physiological pain

● Use of PQRSTU, behavioral pain scales, and/or critical care pain observational tools is then needed to identify all aspects of pain.

● Identify and discuss a pain management plan with the patient prior to intervention

● Based on this knowledge the nurse can apply various pain management therapies

○ If pain is above a tolerable level, begin each pharmacological pain medication at it’s lowest therapeutic dose and titrate when/if necessary.

○ If pain is below a tolerable level, non-pharmacological interventions are helpful (Barr et al., 2013)

 

EB Nursing Recommendations: Julie Zuckerman

Pharmacological Recommendations:

● For patients in the critical care unit who have undergone surgery:

 

IV morphine or IV promethazine (Sattari, Baghdadchi, Kheyri, Khakzadi & Mashayekhi, 2013).

● For patients who are increasing with age or have multiple comorbidities:

 

○ Start with the safest drug first and then escalating treatment if not relieved.

○ Paracetamol first, followed by NSAIDs and a gastroprotective agent, then opioid analgesics

 

(Diallo & Kautz, 2014)

Non-Pharmacological Recommendations:

Use of these therapies can help decrease tolerable pain levels and increase comfort level

 

○ harp music

○ cold application

○ Music therapy

○ lavender essential oils

○ natural sounds

○ Distraction, simple massage and family presence facilitation

Implementation Keelie Gallagher
Implementation Keelie Gallagher
Implementation Keelie Gallagher
Implementation Keelie Gallagher

Implementation

Keelie Gallagher

Implementation: Keelie Gallagher

Finding educator ~5 days Awareness/Sign ups ~ 7 days Working with facility ~7 days Education
Finding educator
~5 days
Awareness/Sign ups ~
7 days
Working with facility
~7 days
Education Sessions
~28 days
Evaluation ~21 days
Wk 1
Wk 2
Wk 5
Wk 8
Wk 9
Wk10
Wk 3
Wk 6
Wk 7
Wk 4

Total time: Approximately 10 weeks from start to finish

Cost Analysis Keelie Gallagher
Cost Analysis Keelie Gallagher
Cost Analysis Keelie Gallagher

Cost Analysis

Keelie Gallagher

Cost Analysis:

Keelie Gallagher

2hr training session with information flyers provided by the educators to the nurses.

2hr training session with information flyers provided by the educators to the nurses.

Cost of educator: $52.89/hr x88 hrs of training sessions=$4,654.32 Cost of flyers: ~$3.00 Cost of

Cost of educator: $52.89/hr x88 hrs of training sessions=$4,654.32 Cost of flyers: ~$3.00 Cost of nurses’ time: ~$32.08/hr x2hrs= $64.16/nurse/training session x20 nurses= $1,283.20 Cost of nurses to cover the nurses who are being educated: ~$32.08/hr x2hrs= $64.16/nurse/training session x20 nurses= $1,283.20 Cost of monitoring pain assessment and reassessment: $0 Cost of pharm intervention on average per med package: $102.70 Cost of non-pharm intervention: Music ($10 cd on repeat), Aromatherapy ($25*20rooms=$500), Basic Massage by nurse ($0), temp therapy ($0)

Total Cost: $7836.42 (Education training $7223.72, Intervention $612.70)

Total Cost: $7836.42 (Education training $7223.72, Intervention $612.70)

Cost of similar program at other facilities: As compared to UCLA’s “Teach back for Pain

Cost of similar program at other facilities: As compared to UCLA’s “Teach back for Pain Management Program,” our program is much more expensive.

Management Program,” our program is much more expensive. (Scherrey, 2016) & (Vallerand, Sanoski, & Deglin,

(Scherrey, 2016) & (Vallerand, Sanoski, & Deglin, 2013)

Why is this important to implement despite cost?

One of the major side effects of illness and procedures is pain. Because patient satisfaction and progress toward wellness are the highest priorities when caring for patients, pain management must be implemented using the most effective and efficient means necessary. If pain is controlled appropriately and effectively, the patient may feel better and desire to get well. Making the patient happy can also increase the hospital’s reputation regarding patient care. In conclusion, providing pain management despite costs will benefit both the patient and the hospital.

Risk vs. Benefit Alyssa McCormick
Risk vs. Benefit Alyssa McCormick
Risk vs. Benefit Alyssa McCormick

Risk vs. Benefit

Alyssa McCormick

Risk vs. Benefit: Alyssa McCormick

(Wells, Pasero, & McCaffery, 2008)

Patient

Nursing

Hospital

Pasero, & McCaffery, 2008) Patient Nursing Hospital ● Addiction ● Dependence ● SE ● Physical Safety

● Addiction

● Dependence

● SE

● Physical Safety

● Time

● Med Errors

● Hard to assess pain

● Monitoring for SE

● Cost of medication

● Lawsuits

Risk

Benefit

● Adequate pain relief

● Faster Healing

● Less Anxiety

● Decreased Stay

● Increased pt-nurse interaction

● Easier to detect other problems

● Better pt outcomes

● Better pt satisfaction

● Cost for Stay

Evaluation/Outcomes Kimberly Wallace
Evaluation/Outcomes Kimberly Wallace
Evaluation/Outcomes Kimberly Wallace

Evaluation/Outcomes

Kimberly Wallace

Evaluation

Kimberly Wallace

-100% of ICU nurses will have attended the educational seminar regarding pain management within the four weeks.

-75% of nurses will have documented pain response within appropriate amount of time after administering pain medication 3 weeks after training.

-75% of nurses will document non-pharmacological pain management, including pain response, in 3 weeks after training.

-75% of nurses will document the entirety of PQRSTU in 3 weeks after training.

Summary Meghan Callahan
Summary Meghan Callahan
Summary Meghan Callahan

Summary

Meghan Callahan

Summary:

Meghan Callahan

● Pain management is a priority in the ICU

● Pain is currently not being well controlled

● Nurses are patient advocates including the patient’s pain concerns

● Evidence shows that pharmacological treatment is more effective than non-pharmacological treatment

● Non-pharmacological treatment, such as music and aromatherapy, is complementary to pharmacological treatment, such as opioids

● Educating staff and nurses about appropriate pain interventions, depending on the circumstances, and implementing the teaching takes approximately 10 weeks to complete

● The total cost of paying for the education sessions, nurses, and treatments is $7,836.42

● The risks of implementing this new approach to pain management include medication errors and medication dependency or addiction

● The benefits of implementing this new approach to pain management outweighs the cost because patient satisfaction and progression toward wellness may improve

References

Barr, J., Fraser, G.L., Puntillo, K., Wesley, E.E., Gelinas, C., Dasta, J.F., Davidson, J.E., Delvin, J.W., Kress, J.P., Joffe, A.M., Coursin, D.B., Herr, D.L., Tung, A., Robinson, B.R., Fontaine,

D.K., Ramsay, M.A., Riker, R.R., Sessler, C.N., Pun, B., Skrobik, Y., Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in

adult patients in the intensive care unit. The Society of Critical Care Medicine, 41(1), pp. 263-306.

Centers for Disease Control and Prevention. (2012). Improving the way opioids are prescribed for safer chronic pain treatment. Retrieved from:

https://stacks.cdc.gov/view/cdc/36833/cdc_36833_DS1

Centers for Medicare & Medicaid Services (2011). Summary of HCAHPS survey results: executive insight. Retrieved from:

www.hcahpsonline.org/files/Summary%20of%20HCAHPS%20Survey%20Results%20Table%20Report_HEI_April_2011.pdf

Chiasson, A. M., Baldwin, A. L., McLaughlin, C., Cook, P., & Sethi, G. (2013). The effect of live spontaneous harp music on patients in the intensive care unit. Evidence-Based

Complementary and Alternative Medicine, 1-6. doi:10.1155/2013/428731

Diallo, B., & Kautz, D. D. (2014). Better pain management for elders in the intensive care unit. Dimensions of Critical Care Nursing : DCCN, 33(6), 316-319

Ertuğ, N., & Ülker, S. (2012). The effect of cold application on pain due to chest tube removal. Journal Of Clinical Nursing, 21(5/6), 784-790. doi:10.1111/j.1365-2702.2011.03955

Gelinas, C., Arbour, C., Michaud, C., Robar, L., & Cote, J. (2013). Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management. Nursing in

Critical Care, 18(6), 307-318. doi:10.1111/j.1478-5153.2012.00531

References

Jafari, H., Zeydi, A. E., Khani, S., Esmaeili, R., & Soleimani, A. (2012). The effects of listening to preferred music on pain intensity after open heart surgery. Iranian Journal of Nursing

and Midwifery Research, 17(1), 1–6.

Martorella, G., Boitor, M., Michaud, C., & Gelinas, C. (2014) Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in

the intensive care unit. Heart & Lung: Journal of Acute & Critical Care. 43(5):437-444. doi: 10.1016/j.hrtlng.2014.06.047

Saadatmand,V., Rejeb, N., Heravi-Karimooi, M., Tadrisi, S.D., Vaismoradi, M., Jordan, S. (2015). Effects of natural sounds on pain: a randomized controlled trial with patients

receiving mechanical ventilation support. Pain Management Nursing, Volume 16(4), pp. 483-492.

Salamati, A., Mashouf, S., Sahbaei, F., & Mojab, F. (2014). Effects of inhalation of lavender essential oil on open-heart surgery pain. Iranian Journal of Pharmaceutical Research:

IJPR, 13(4), 1257–1261.

Sattari, M., Baghdadchi, M. E., Kheyri, M., Khakzadi, H., & Mashayekhi, S. O. (2013). Study of patient pain management after heart surgery. Advanced Pharmaceutical Bulletin, 3(2),

373-377

Scherrey, J. (2016, August). Teach back for pain management. Retrieved from http://nursing.uclahealth.org/body.cfm?id=285

Smith, H., & Bruckenthal, P. (2011). Implications of opioid analgesia for medically complicated patients. Drugs & Aging, 27(5), 417-433. doi:10.2165/11536540-000000000-00000

Wells, N., Pasero, C., & McCaffery, M. (2008). Chapter 17 improving the quality of care through pain assessment and management. In R. Hughes (Ed.), Patient safety and quality: An

evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality.

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Davis's drug guide for nurses (13 ed.). Philadelphia, PA: F. A. Davis Company.