When 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.

I 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 1347^th 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 1347^th 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.