Matching Interventions to Barriers in Pain Management

1. Matching Interventions to Barriers in Pain Management

2. National Institute of Clinical Studies Role: To improve health care by helping close important gaps betweenbest available evidence andcurrent clinical practice

4. Acknowledgements Prof. Sanchia Aranda NICS advisors Deb Gordon & June Dahl (Wisconsin pain group) Pilot hospital teams

5. Pilot hospitals

6. Background www.nicsl.com.au

7. Aims To improve the identification of patients with pain To improve the day-to-day management of pain for patients with cancer To integrate effective cancer pain management into the core business of hospitals

8. Barriers - Institutional Lack of institutional commitment Poor visibility of the problem Professional territorial issues Unclear lines of responsibility Lack of practical tools & policies

9. Barriers � Clinicians Attitudes & beliefs of staff No routine pain assessment Under-estimation of patients� pain Analgesia misconceptions Prescribing & administration inconsistencies Inadequate knowledge and education

10. Barriers � Patients Inevitability of pain Stoicism Analgesia fears & misconceptions Being a �good� patient Distracting from treatment Trade-offs: analgesics & side effects

11. Where to start?

12. Matchinginterventions to barriers

13. Lack of knowledge Educational courses Evidence based guidelines Decision aids Beliefs/Attitudes Peer influence Opinion leaders Lack of motivation Incentives / sanctions Perception-reality mismatch Audit & feedback Reminders Systems of care Process redesign Generic Principle

14. Institutional Lack of institutional commitment Executive champions Peer hospitals? Poor visibility of the problem Audit & feedback to executive We have a problem!

15. Institutional Professional territorial issues get everyone involved multiple champions

17. Clinical Inadequate knowledge, education needs analyses useful don�t expect attendance at special meetings use existing meetings opportunistically include in orientation, rounds, intranet nursing competency standards Medical and nursing staff have different needs for information (as heard earlier today from Royal Perth). Pharmacists can be excellent neutral deliverers of education on analgesia to both camps. Special meetings are fraught with danger - people do not have extra time in their schedules. Ian Olver quote - "get people where they are" Medical and nursing staff have different needs for information (as heard earlier today from Royal Perth). Pharmacists can be excellent neutral deliverers of education on analgesia to both camps. Special meetings are fraught with danger - people do not have extra time in their schedules. Ian Olver quote - "get people where they are"

18. Clinical Attitudes and beliefs Opinion leaders Clinical champions Peers Attitudes and beliefs of clinical staff are probably the most difficult barrier to tackle head-on. Addiction myths persist. Under-estimating patient's pain persists. Do we know better than the patient? One single experience of respiratory depression with morphine, can alter a person's practice forever. Attitudes and beliefs of clinical staff are probably the most difficult barrier to tackle head-on. Addiction myths persist. Under-estimating patient's pain persists. Do we know better than the patient? One single experience of respiratory depression with morphine, can alter a person's practice forever.

19. Clinical No routine assessment documented pain scores on vital sign chart reminders audit & feedback essential Implementing routine pain assessment is harder than it sounds. Audit and feedback is essential because there is often a perception-reality mismatch - people think they are doing a better job than they really are Implementing routine pain assessment is harder than it sounds. Audit and feedback is essential because there is often a perception-reality mismatch - people think they are doing a better job than they really are

20. Clinical Prescribing inconsistencies guidelines and decision aids at point of prescribing equi-analgesia cards standardised prescribing Mandy Layzell gave a good example today of the power of simple interventions - pre-printed analgesia labels for medication charts. And almost every site in the NICS program introduced equi-analgesia cards which proved very popular - not surprising given the vast array analgesia now available, particularly in cancer care.Mandy Layzell gave a good example today of the power of simple interventions - pre-printed analgesia labels for medication charts. And almost every site in the NICS program introduced equi-analgesia cards which proved very popular - not surprising given the vast array analgesia now available, particularly in cancer care.

21. Patient Inevitability of pain; stoicism; being a "good" patient "your pain is important to us" organisation mission statement hospital admission/discharge information includes pain management ward posters

22. Patient Distracting from treatment "your pain is important to us" involve patient in their own pain management prompts to discussion Hmm� don't know about this oneHmm� don't know about this one

23. Patient Analgesia fears, misconceptions (particularly addiction) starting morphine is a "threatening procedure" for cancer patients information for patients & families

24. Matchinginterventions to barriers

25. Begins with a sound analysis of barriers