Pain Management


An L&D Story: How a Good Patient Experience Could Have Been Great

Patient Experience and L&D

In March, my wife and I were thrilled to welcome our second child to the world. Our baby boy was born healthy and we could not be more thankful. I did catch myself taking notes, however, as I’ve been working closely with Always Culture and learning about best practices for providing an optimal patient experience. Our overall experience was good, but there were some areas of opportunities that, if addressed, could have made it great.

Our son was a big boy – over 9 pounds, and my wife is very petite, so a few days before the due date her doctor advised that we schedule a cesarean. We gratefully accepted. My wife’s water broke with our first child, and it was like one of those movie scenes where you rush to the hospital, so it was weird just showing up at a certain time to have the baby. Weird, but nice. We stayed for two nights.

COMMUNICATION

We didn’t have any really bad interactions with nurses, but we could tell a difference between the providers that were just going through the motions, trying to get through their shift, and the ones that were actually engaging with us. Right off the bat, they were asking some intake questions and mixed in with medical history, medications, and the like, was this one: “Have you ever thought of hurting yourself or anyone else?” The nurse asked it in the same casual tone that she asked about cigarette smoking. I couldn’t help but think that if the answer was “yes”, would anyone feel comfortable saying so? What would the follow-up be? It just seemed like a very personal and intimate detail that should have been approached with a bit more care.

After the baby came, we were like many parents with newborns; exhausted, delirious, and looking for the staff to assure us that our son was doing well. We may actually be a bit more sensitive than many parents. I know I tend to look for things to worry about when it comes to my kids. That’s why I replayed every word I heard from the care team over and over in my mind.

There is no “routine” for patients and their families

I remember at one point the pediatrician came in and asked us how the baby’s blood sugar was. I was thinking “I don’t know… let me ask the doctor!” The question was completely out of left field. I felt like there was something going on that we didn’t know about. I pestered the next few people who came in the room about “have you heard anything about his blood sugar?” They hadn’t. It was fine. I don’t know why the doctor asked the question, but I learned that routine communication is not routine for patients and caregivers.

Empathy goes a long way

We had a couple of nurses that I wish I could give a million dollars each. They were truly caring toward my wife. They listened, asked questions to discover what was important to her, and had empathetic responses that made us feel like we were in good hands. Breastfeeding was something that we were especially focused on because we had struggled with our first child. We knew we wanted to get as much advice as we could while we were in the hospital. Even though the nurses and lactation consultants didn’t have all the answers, the time spent with us “in the trenches” meant the world to us.

The last thing I would say about communication is that I wish that all of the staff had utilized the communication boards. Some did, but most didn’t. Time doesn’t seem to exist those first few days, so it’s helpful to know what meds you can have when, remember who your nurse is now, and how she can be reached if needed.

RESPONSIVENESS

There were only a couple of times during our stay when I got upset. They both had to do with responsiveness. After my wife’s catheter was removed, it took a while before she could go to the restroom on her own. While she waited, her pain (and anxiety) continued to build until it became unbearable. She had been told not to try and use the restroom on her own, but she really wanted to try so she could relieve the pain. We were unable to get help to the restroom. Multiple calls using the call light didn’t work. The staff that answered the call seemed indifferent and a little put off that they had been bothered.

Eventually, I helped her to the toilet and she was able to relieve her pain (and bladder). The nurse arrived while she was in the restroom, and I was a little surprised that she didn’t stay to help her back to bed. In general, the call lights seemed to be completely ineffective. There were several occasions when she needed pain meds that I eventually went out to the nurse’s station because it was the only way we could get help. I don’t know what she would have done had she been alone.

Shift Reports and Rounding set the tone for attentive care

We never experienced a bedside shift report or regular rounding. We often found ourselves just hoping someone would show up soon, and often expecting to have to track someone down. Several hours after one shift change I went to the nurse’s station asking if we could get some medication and they asked who my nurse was. I had to respond, “I don’t know, we never met her.” Despite having some sub-par experiences, it’s amazing how one person can turn it around. It was the nurse at the station who asked me who my nurse was. She understood that the ball had been dropped and she picked it up. She got my wife’s medication and set clear expectations for when we could expect to see her again. After finding the nurse assigned to us, she had taken over our care personally. Each shift change we had been hoping that we would get a nurse who was paying attention. She was a breath of fresh air.

Any inpatient stay is a vulnerable time for patients and their families, even on joyous occasions like childbirth. Having a caregiver who is truly paying attention makes all the difference in the world. Implementing best practices like bedside shift reports, regular rounding and communication boards can help make a patient feel like they are being cared for and make a good experience an exceptional one.

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Opportunities for Collaborative Care in Pain Management

collaborative careWhen it comes to improving pain management scores, and improving pain management in general, we must consider that there is not one singular solution. Hospitals that are willing to work together inter-departmentally to assure their patients feel that their pain is being addressed, will be rewarded with an increase in positive feedback from the people they serve.

Often times, this requires putting departmental pride aside and reaching out to other health professionals to create an environment that allows our patients to hear the same information from several sources. By encouraging interaction with and reiteration by physicians, nurses, pharmacists, and other healthcare professionals, patients have a better chance to receive, understand, and truly learn the information being shared. In this way, patients become a part of their own care and healing and have insight into both their treatment and the likely duration of their discomfort.

Physicians

Doctors are typically the first person that a patient thinks of when he is suffering from an ailment or disease. Your patient in the hospital has had at least some interaction with a physician on his path to his current condition. Patients also tend to understand, though, that while doctors may round occasionally, they will not be their main contact during their hospital stay.  Most patients, however, trust the physician’s word more than any other he will hear during his stay.

When the physician does arrive in a patient’s room, it is imperative that she spends time truly listening to her patient, answering questions, and explaining methods to address the patient’s pain. Beyond these basics, physicians must manage up the nursing staff as partners in their pain management, and discuss their pain goals with the patient as an active member in their care. This interaction with the doctor assures the patient that his primary contact is still involved in his care and that the nurses, who are in more constant contact with him, are working in agreement with the physician.

Nurses

Patients will have more interaction with their nurses than with anyone else in the hospital. This first line of care is one of the most important components in determining the patients’ perception of their hospital stay. Nurses have the opportunity and responsibility to educate their patients when it comes to medications. By communicating often and honestly, nurses are in the best position to help a patient set realistic goals about his pain management. The reiteration of the name of their medication, the reason the medication was prescribed, and the potential side effects help educate the patient and include them in their own healing.

Nurses also have the chance to reiterate the suggestions of other health professionals – it is the nurse who can remind the patient to call for help before attempting to walk alone (“like your physical therapist told you”) or to try to eat (“remember your doctor wanted to you to drink 8 ounces by mouth”). This unique position of offering care while managing up your fellow healthcare workers puts nurses at the forefront of the collaborative care effort.

Of course, the other health professionals that interact with the patient should also be repeating information about medication, precautions, and goals as necessary. While that may seem redundant, knowing that the there is a team of health care experts collaborating together on their behalf offers an assurance that is invaluable to the patient.

Pharmacists

Pharmacists are an essential part of increasing a patient’s confidence in her healthcare and, as such, should be included as a patient educator whenever possible.

Pharmacy is defined as the art, practice, or profession of preparing, preserving, compounding, and dispensing medical drugs. Taking a prescription from a physician and delivering the exact medication to treat a patient truly is an art form. And, while we, as healthcare providers, interact and distribute medication every day, the pharmacist is the best choice to explain to the patient the reasons for and ramifications of any medicines he is taking.

Research has shown that rounding by pharmacy managers improves education and minimizes errors from non-compliance. In hospitals where pharmacists round, patients have a better perception of their pain management and medication communication. The idea that they are receiving a collaborative effort in regards to their healthcare increases patients’ overall outlook of their hospital stay.

Other Health Professionals

Patient interactions are not limited to physicians, nurses, and pharmacists – there are scores of other health professionals who will spend time with the patient during her time in the hospital. Therapists, technicians, and dieticians will all take part in a patient’s care plan and should be working with the other healthcare providers to create a cohesive plan. They should be reiterating parts of the plan that have already been established and communicating additions to the care of the patient that fall under their expertise.

A patient who sees and experiences the collaborative care of all her health professionals working together with her will have a much more positive outlook on her care. She will also have a better understanding, albeit with more realistic expectations, of her healing and pain management. 

Administrative Responsibility

This environment of interdepartmental cooperation must start from the top down. A culture shift within a hospital must be lead by an administration who appreciates the benefits of collaborative care for their patients. Administrators must understand that cooperative care changes the outlook of patients on their overall stay in the hospital by making them feel considered and valued.

There must be leadership in creating a patient-centered culture. Hospital administration has to lead the charge in making resources, training, and focus on the patient experience a priority. Once it is clear that the patient has become the heart of the hospital, staff will adopt and embrace this belief. Slowly, this philosophy will trickle down to directors, managers, and front-line staff and create an Always Culture for every patient who enters your doors.
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How to Make Your Pain Management Efforts More Honest and Human

pain management - honest and humanWhen patients are admitted into our hospital, not only do they come in with their own expectations of the care they should receive, but most of the time our patients’ time spent in the hospital is accompanied by pain.

Whether they have this pain before they come in, or after they undergo a procedure, pain can affect our patients’ mind, body, and spirit. Pain also influences how patients perceive their pain management and overall care. Effective pain management is essential to maintaining a positive patient experience, as well as a basis for comprehensive and compassionate care.

Listen

The first step in setting expectations is taking the time to listen to the patients. As providers, we are bombarded with tales of pain and woe throughout every shift we work, but for your patients, the pain they are experiencing is new, foreign, and frightening. By truly listening to their complaints, you will be able to better understand how to treat their specific needs.

Involve the family of the patient in this step as well. While some patients want to tell us every ache and pain they experience throughout the day, others are hesitant to “trouble” us. Patient families are excellent sources of information in these circumstances.

Managing Expectations

Before you administer a medication, take the time not just to let your patient know what you are giving them and why, but really take that time to set their expectations. As a basis, you should explain the medication you are giving, the dosage, why it is being given, and possible side effects. Additionally, let your patient know how long she will need to wait until the medication takes effect, and set a time that you will return to check on how her pain is progressing.

Repeating this information every time you administer the medication may seem like a redundant waste of time, but your patients are not health professionals. Their medications have unfamiliar names and it takes them time to learn the purpose behind each drug they are taking. By reciting the name, dosage, reasons given, and possible side effects each time you administer it, you are empowering the patient to learn more about her treatments and take ownership of her own healthcare.

Set Goals

Once you have heard what your patient is experiencing, work with the patient and his family to set realistic pain goals. Medications and treatments are not going to eliminate pain, instead, they are designed to control it. When creating a pain control plan with the patient, avoid statements like, “This will take care of that pain…” or “This medication will knock that pain right out…” These only serve to patronize our patients. Patients don’t want to be placated or dealt with as if they were a problem to solve; instead, they appreciate honest communication.

Trust your patient’s assessment of his own pain, and develop his pain goals with him and his family. Whether the pain goal is to decrease the pain to a certain level, or to decrease their pain by a certain amount, work with the patient to create common expectations.

Use this opportunity to set other goals as well. These goals can include functional goals about mobility, goals about sleeping, or even emotional goals. As long as you work together with your patient and his family in creating the goals, everyone involved in his care will be on the same page and work towards the same goals.

Alternative Pain Management

While, for many patients, their idea of pain management includes using pain medication, others may appreciate the suggestion of alternative or non-pharmacological, methods. These can include everything from simple efforts such as repositioning, heat or ice, or even hand-holding; environmental changes like aromatherapy or music therapy; skilled modalities such as massage or acupuncture; or even simple distraction techniques like exercise, using a mobile device, reading, or welcoming visitors.

The particular method of alternative pain management is not really the issue here. The idea is that, by suggesting alternative methods in addition to pain medication, you will drive home the idea that you are doing everything you can to manage your patient’s pain.

Conclusion

Patient education is probably the single best practice you can employ to improve your patients’ perception of their pain management. Studies have shown that patient education and patient involvement in setting goals not only impacts the patient’s perception of their pain management, but patients have even reported decreased and more tolerable levels of pain.

By listening closely, working with your patient to set goals, maintaining expectations, and offering alternative options when it comes to pain management, you will be able to create an Always Culture in your healthcare facility.
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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.
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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.
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[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


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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