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3 Keys to an Effective Pain Management Culture

effective pain management cultureI recently took my family to one of the new “escape room” experiences that seem to be popping up everywhere. Upon entering we were introduced to our Escape Room Professional (let’s call him Carl), and as he walked us over to our particular room he began explaining the process and rules of the game. However, it was obvious from how quickly Carl was muttering under his breath, that this must have been the 1347th time he had given this particular speech. In fact, it took a minute for me to realize that not only was he talking to us, but he was giving us instructions on how to play the game. At one point I actually had to stop Carl and ask him to speak more slowly, but even this didn’t help much. In the end we played, figured out the clues and got out within an hour—we had a great time. But, the whole thing was a bit hampered for me by our initial experience.

For my family and I, this was our very first escape room experience—we had no idea what we would see or do. For Carl, he was 5 hours into a Saturday shift and this was number 14 of the 30 appointments that would come through that day. He knew the speech he was supposed to give, and in his mind, the quicker he could get the speech out, the quicker he could get to the next group of hopeful escapees. But, while Carl was busy checking off his “gave the speech” box, my family and I were left off-balance, confused, and a little frustrated.

While this fun outing in no way comes close to a healthcare or patient experience, what is comparable is the absence of treating a new customer or patient as if each new experience is new to them. What this requires is true empathy.

Empathy

For the thousands of patients we will see in our careers, we must never forget that for them, this could be their first time for everything. For us, we are 5 hours into a 12 hour shift, we have 6 other patients, and this is literally the 1347th admit we have done in our career—but for the patient in the bed, and for the family in the room, this is a brand new experience. An experience tied to anxiety, fear, uncertainty, and in many cases, pain. Our patients and their families deserve a fresh attitude from us that calms their fears and anxieties, and lets them know that they are being cared for by someone who can empathize with them. Pain is a nearly universal symptom for our patients, and our first method of treatment should be true empathy for their situations.

Checking Our Assumptions

Our attitudes towards our patients can affect their stay greatly, and when it comes to pain control and pain management strategies we need to do some serious self-evaluation and ensure we are approaching each patient with compassion.

Empathy is the first step to making sure our mindset is correct as we interact with our patients, but to take it a step further, we need to treat each patient as an individual and not compare them to every patient or case that has come before. After treating hundreds or thousands of patients, it is understandable that we could become skeptical of patients’ complaints of pain, but we need to eliminate giving our patients the tags of “drug-seeking” or “addicts” before we learn about their cases.

While it is a reality that some patients falsify or exaggerate their claims of pain, we must respect our patients’ pain complaints or we run the risk of going from being skeptical to dismissive. If we really are going to do everything we can to address our patients’ pain, then we must begin by listening to them openly and without judgment.

Giving Our Patients Some Credit

Our patients are not children. Well…at least metaphorically. Even if you do treat pediatric patients, this can still apply to you. As caregivers we can sometimes fall into the trap of treating our patients like children—patronizing them and over-simplifying certain details of their care.

This can be especially true in pain management, when open and honest communication is essential. We must give our patients the benefit of the doubt that they can accept a realistic view of pain control—that pain control does not mean the elimination of pain. This requires a concerted effort to not only be honest and set realistic and functional pain goals, but it requires that we give each patient a clean slate as they begin their stay.

Yes, there will always be those patients who expect the impossible and have completely unrealistic views of pain management, but these patients must present themselves to us—we cannot use a patient’s background, history, or appearance to dictate how we view them before their treatment begins.

Back to the Room

So, did Carl’s rushed and half-hearted introduction ruin my family’s escape room experience? No. But, if he had assumed that this was our first game and put some time and effort into his introduction, would it have made our experience better? Absolutely.

How much more could efforts like these affect our patients and their families? Having a mindset of true empathy, putting aside our pre-conceived notions and assumptions, and giving our patients some credit can make all the difference in creating an effective pain management culture.
5 Areas of Focus for HCAHPS eBook




[PODCAST] Adjusting the Discharge Process for Improved HCAHPS Scores

There are five questions on the HCAHPS survey dealing with the discharge home, or the transition of care, and they all center around the patient’s level of understanding of their discharge instructions and your staff’s level of understanding of patient preferences. For improved HCAHPS scores, we need to recognize a problem with the discharge process: we, as health care providers, have designed the process for us and not for our patients.

Listen to the podcast to learn tactics for improving the discharge process or checkout the full video and article: Adjusting the Discharge Process for Improved HCAHPS Scores

5 Areas of Focus for HCAHPS eBook




4 Requirements for Effective Pain Management and Patient Satisfaction

What does it mean to control pain?

patient satisfaction through effective pain managementPain is almost a universal symptom for our patients, and depending on their coping mechanism and pain threshold, each person experiences pain in their own way. Naturally, a patient’s pain can affect their experiences and perceptions, but it should also be noted that the patient’s environment and experiences can also affect their pain.

In a study by the American Pain Society, it was noted that patients reported worse pain when they perceived their providers to be uncaring.  This study also showed that the effect can work positively as well.  Patients reported that their pain was effectively controlled when expectations were set, they were informed and included in their pain management plan, and staff frequently assessed their pain.

When a patient’s pain is effectively controlled they are more comfortable, more willing participate in their care, and are more likely to have good outcomes. Clearly, pain can affect our patients’ mind, body, and spirit, not to mention how they perceive their pain management and overall care.

What does it mean to effectively manage and control pain? It may not be what you think.

In a study by the Gallup Business Journal, it was noted that not only are certain levels of pain necessary for diagnosis, but it showed that it is not necessary to completely eliminate a patient’s pain in order for a them to perceive that their pain was well controlled.

Clearly, effective pain control is not about completely eliminating pain, nor is it about just giving meds. It’s about building trust by listening, communicating, and working with our patients to set realistic pain goals.

In upcoming posts on pain management, we will be addressing four main tactics and best practices. These four key needs for effective pain management are:

            Hospital Culture / Staff Attitudes

Not only do we need to eliminate the automatic labeling of patients as “addicts” or “drug seekers”, but we must respect our patients enough to partner with them, not just simply placating their pain complaints.

            Setting Patient Expectations and Goals

Trust and honesty are essential to making a pain control plan with our patients. We need set expectations and communicate with our patients that pain control does not mean completely eliminating pain, but it means reducing  pain to a manageable level.

            Consistency & Medication Administration Processes

As with any patient quality or patient satisfaction initiative, consistency is key. Specifically, we need to be consistent in the repetition of a scripted medication administration process.

            Administration Buy-in & Leadership

No initiative, policy, or best-practice can survive and be successful without solid front-line leadership and a strong sense of buy-in from hospital administration.

These tactics and best practices do not highlight specific pain control methods. They are ways to include your patient in their care, set their expectations, educate them on their own medications, and ensure that you are doing all you can to control their pain.
5 Areas of Focus for HCAHPS eBook




[PODCAST] Effective Pain Management for HCAHPS Improvement

Nearly every patient that comes into the hospital arrives with pain. Controlling pain and working towards HCAHPS improvement can be a challenge.

The HCAHPS survey asks two questions with regards to pain management:

“How often was your pain well-controlled?”

 “How often did hospital staff do everything they could to help you with your pain?”

Listen to the podcast to learn tactics for improving pain management techniques or checkout the full video and article: Effective Pain Management for HCAHPS Improvement


5 Areas of Focus for HCAHPS eBook




[PODCAST] Communication on Medications Effects HCAHPS Scores and Patient Safety

Communication with patients on medications is important for both patient experience, HCAHPS scores, AND patient safety.

Listen to the podcast to learn tactics for improving communication on medications or checkout the full video and article: Communication on Medications Effects HCAHPS Scores and Patient Safety

5 Areas of Focus for HCAHPS eBook




[PODCAST] The Metric that Most Correlates with Overall HCAHPS Ratings

When a patient sits down with their HCAHPS survey to answer questions on how they communicated with their nurses, they’re going to be answering questions based on just about every communication they had with all staff members at the hospital…

Listen to the podcast to learn tactics for improving patient communication with nurses or checkout the full video and article: The Metric that Most Correlates with Overall HCAHPS Ratings

5 Areas of Focus for HCAHPS eBook




[PODCAST] 2 Key Measurements for the HCAHPS Survey Responsiveness Score

The HCAHPS survey asks about the measure of responsiveness in a very specific way. It doesn’t ask about responsiveness as it relates to how food trays are delivered, how medications are handled or how transportation is provided throughout the hospital. The HCAHPS survey asks about responsiveness in two specific areas…

Listen to the podcast to learn what those are and for steps on improving your Responsiveness Score or checkout the full video and article: 2 Tactics for Improving HCAHPS Scores AND Overall Patient Experience

5 Areas of Focus for HCAHPS eBook




[PODCAST] 2 Tactics for Improving HCAHPS Scores AND Overall Patient Experience

What does it take to create a great patient experience and promote HCAHPS scores that reflect high quality of care?

Patient experience is subjective. It’s subjective for you, for me, and for anyone who’s lying in a hospital bed. Every individual perceives their care differently, and that’s the challenge.

Listen to the podcast, or checkout the full video and article: 2 Tactics for Improving HCAHPS Scores AND Overall Patient Experience

5 Areas of Focus for HCAHPS eBook




Adjusting the Discharge Process for Improved HCAHPS Scores

The unfortunate truth is that no patient wants to be in your hospital and everyone is focused on going home.

There are five questions on the HCAHPS survey dealing with the discharge home, or the transition of care, and they all center around the patient’s level of understanding of their discharge instructions and your staff’s level of understanding of patient preferences. For improved HCAHPS scores, we need to recognize a problem with the discharge process: we, as health care providers, have designed the process for us and not for our patients.

Start at Admission

Patients need discharge information sooner than the last day of their stay. Why not start the process at admission? Start talking immediately with your patients about: 

  • Who are they going home with?
  • Who is their primary caregiver?
  • Do they need equipment?
  • Do they need extra help?

These questions should be addressed right from the beginning of their stay.

improved hcahps scores

Written Instructions

Every facility has a written packet of discharge instructions that includes precautions for going home and information on medications. This critical information should be presented at the beginning of a patient’s stay so that more education can take place and any questions that come up can be answered long before the patient walks out the door.

It’s true that medications can change toward the end of the stay, but why not start by giving them the precautions for the surgery that we know they’ve already had? Give them information on the medications we know they’ll be going home with, and not just for them to have it, but for us to reference it. Every time staff visits the room to discuss and administer a medication, it’s a great opportunity to pull out the discharge information.

Ideally, at the hour of discharge, the patient should be able to tell you about their precautions and medications rather than the other way around.

Proven Process

The discharge process should be repeatable for every patient, every time. Yes, discharge instructions should be discussed throughout the entire stay, beginning at admission, but at that moment of discharge there are six main steps that should be followed:

  1. Discuss the diagnosis.
  2. Follow up with any treatments that were done and the results of those treatments.
  3. Go over any test results.
  4. Discuss any symptoms that they can look for when they go home.
  5. Discuss any follow-up appointments.
  6. Go over instructions on any medications that will be taken at home. Medication Communication is a primary focus of the HCAHPS survey.

This is a process (for patients and improved HCAHPS scores) that should be repeated for every patient at every discharge, but more importantly, remember to start discharge planning at admission, and keep the conversation going throughout the entire stay.

5 Areas of Focus for HCAHPS eBook




Effective Pain Management for HCAHPS Improvement

Nearly every patient that comes into the hospital arrives with pain. Controlling pain and working towards HCAHPS improvement can be a challenge.

The HCAHPS survey asks two questions with regards to pain management:

“How often was your pain well-controlled?”

 “How often did hospital staff do everything they could to help you with your pain?”

Remember, these answers are on a scale from never to always, so consistency is the key.

HCAHPS Improvement & Pain Management

What does it mean to effectively control pain? It might not be what you think. To effectively control pain (or work towards HCAHPS improvement), we do NOT need to completely eliminate a patient’s pain. In fact, there are certain levels of pain that are necessary for diagnosis. More importantly, studies have shown that patients do not need to have their pain eliminated to experience good pain management. To manage pain effectively, patients need to feel that they have a partner, someone who is working with them on their pain management plan, listening, and having an ongoing conversation about progress.

hcahps improvement and pain management

 

Check Your Attitude

As caregivers who have seen hundreds if not thousands of patients talking about pain, it’s all too easy to start stereotyping patients as “drug-seekers” or other negative labels. Resist that temptation. It is incredibly important to give each patient a fresh start so that we can adequately listen to what they’re saying.

Be Honest-Set Attainable Goals

Let your patients know that you’re not going to completely eliminate their pain, but work with them in making a reasonable, attainable, and functionsl pain goal. A pain goal might be a certain level on the visual analog scale, to get from an 8/10 to a 3/10. It might be a functional goal, such as walking in the hall without pain, or walking in the hall a certain distance, or even sleeping through the night without pain. The idea is to find an attainable goal that works for them.

When you set these goals, use the administration time of medications to set their expectations.  After reviewing the medication name, dosage, purpose and side effects, try using a statement like, “I’d expect that in 45 minutes you should be feeling better and your pain level should be decreasing, and I’ll come back then to check on you.” This sets the expectation that you are partnering with them to get the best pain management possible, but you’re not a magician who can make pain disappear. Communication regarding medications is key for multiple parts of the HCAHPS survey.

Alternative Pain Control Methods

The second question on the HCAHPS survey relating to pain management asks, “Did this hospital staff do everything they could to help manage your pain?” That’s a big question. How do you quantify “everything we could?” It’s another one of those vague questions that can be a little frustrating for caregivers. The idea is not necessarily to do one particular thing, but it’s to do everything you can. Some patients may want a non-pharmacological or alternative pain control method. It could be anything from hand-holding to acupuncture, to changing a position, to aromatherapy or music therapy. Your facility may have different solutions available to them, but it’s the idea that you’re going to try to do something, rather than just giving them a pill to take. If they feel that you’ve at least tried something, they’re going to feel that you’ve done everything you can.

The main takeaway to employ with pain management (and HCAHPS improvement) is to simply be honest. Tell your patients that you can’t completely eliminate their pain, but you can work with them to set a goal that is attainable.

5 Areas of Focus for HCAHPS eBook