1. Pain Management at the Bedside : Implementing the Pain Resource Nurse Role at LUHS Team Members: Jackie Murauski, Chair, Liz Barstatis, Sandy Burgess, Anita Calistro, Gail Kellberg, Maureen Kolbusz, Cindi LaPorte, Aimee Stotz, LuAnn Vis, Carol White Loyola University Chicago LOYOLA UNIVERSITY HEALTH SYSTEM

2. The LUHS Pain Management Resource Nurse Team

3. Opportunity Statement For the past 4 years there have been significant efforts to improve pain management for patients at LUHS. Despite efforts, patient satisfaction with pain management remains in the lower third of hospitals in the Press Ganey database Project Goal: To bring pain improvement efforts to the bedside, the LUHS Pain Resource Nurse (PRN) role was developed and implemented in 2002.

4. Pain Resource Nurse Role An experienced health professional: Staff Nurse, Physical Therapist, Occupational Therapist Receives special training in pain assessment & management Develops and implements at least two unit based quality improvement goals for pain management Serves as resource and change agent for their unit/department Provides education to peers, patients, and families Models collaboration with physicians and other health care providers to improve pain management

5. Most Likely Causes Barriers to optimal pain management by staff include: The subjective nature of pain Varied staff knowledge levels related to optimal pain management Limited staff involvement in organizational quality improvement efforts to improve pain management

6. Solutions Implemented Conducted literature review Communicated with other organizations that have implemented the PRN role Gained organizational support for the program Managers identified PRN candidates (Dec 01) Organized & presented 2 day intensive course on pain management (Jan 02) Conducted a PRN needs assessment (Feb 02) PRN’s conducted a unit based needs assessment (Mar 02) PRN’s developed two unit based improvement goals based on needs assessment (Apr 02)

7. Solutions Implemented Supported role through: Monthly meetings: Continuing education on pain topics Sharing of unit based activities by the PRN’s Communication of organization improvement activities Staff education materials Development and distribution of LUHS Steps to Unrelieved Pain Repeated PRN needs assessment after 1 year (Jan 03) Repeated PRN orientation program (Jan 03)

9. LUHS PRN Program PRN Comfort Level After One Year Improvement Noted in 18 of 20 aspects of care

10. Nursing Pain Documentation

11. Analysis Eighty LUHS staff members participate in the PRN role PRN comfort level has improved in 18 of 20 aspects of pain management after one year LUHS nursing pain documentation has improved: Admission notes: increased from 69.7% to 84% compliance Discharge notes: Increased from 90.5% to 95% compliance Several PRN’s conduct unit based documentation audits in addition to house-wide indicators Eighty-six percent of PRN’s report that the role has made a difference on their unit

12. Next Steps Continue to support the PRN role through monthly meetings Provide continuing education on topics identified through the PRN needs assessment Work with PRN’s on goal development and presentations of goals/outcomes to unit staff PRN’s will educate peers on “Pain Talking Points” for use in patient/family education in 2003 Continue to identify program improvement opportunities