1. Pain and Comfort: Who are you to decide Elise ChircoElise Chirco

2. Objectives Recognize the difference between acute and chronic pain Identify 5 negative outcome of persistent pain To discuss how ineffective pain management impacts a facility

3. “Pain affects more Americans than diabetes, heart disease, and cancer combined.” - Nanne M. Finis, R.N., M.S.

4. Issue and Relevance More than 76 million people affected Decreased reimbursement Increased unnecessary ED visits Many causes: Trauma Poor health Surgery Stress Depression Different Types Acute Chronic

5. Chronic Pain Is it real? Is it fake? Who are you to decide?

6. Bernhofer (2012) stated that, “Practitioners who would likely not judge the character of a patient who needs increased amounts of medications to treat hypertension, yet they may believe that a patient whose persistent pain does not respond to standard medications is ‘drug-seeking,’ a narcotic abuser, or has a current need to ‘escape reality’.”

7. Speak Up About Pain Speak up campaign by the Joint Commission

8. Root Cause Analysis Chronic pain is like a weed; there is more below the surface then what is visible. Why is pain not managed in the acute care setting?

9. Assessment of the Healthcare Environment Fear of overmedicating Medication Diversion Withholding medications Failure to assess pain appropriately Pain level is ALWAYS a 10 out of 10 on the numeric pain scale Fear of the physician and patient advocacy Nursing Shortage

10. Implications & Consequences Patient: Poor outcome Unsatisfied with care Nurses Not fulfilling job duties Making a subjective symptom an objective observation Hospital Poor reviews Reimbursement Issues (HCAHPS)

11. Quality & Safety Recommendations Increase knowledge of medications and the side effects **PAIN IS NOT JUST A SYMPTOM! Monitor nursing staff for risk of diversion of medication Teach Alternative therapies Educating patients on how the pain scale is effectively used

12. Theories of Practice Kolcaba’s Theory of ComfortMaslow’s Hierarchy of Needs

13. ANA Standards Standard 7: Ethics Standard 10: Quality of Practice Standard 14: Professionalism Practice Evaluation

14. Questions

15. Thank youThank you

16. References Ang, E., & Chow, Y. (2010). General pain assessment among patients with cancer in an acute care setting: a best practice implementation project. International Journal Of Evidence-Based Healthcare (Wiley-Blackwell), 8(2), 90-96 7p. doi:10.1111/j.1744-1609.2010.00167.x Barrie, J. (2014). The clinical nurse specialist role in chronic pain management services. BritishJournal Of Healthcare Management, 20(12), 558-561 4p. Bernhofer, E. (2012). Ethics: Ethics and Pain Management in Hospitalized Patients. Online Journal Of Issues In Nursing, 17(1), 1-1 1p. doi:10.3912/OJIN.Vol17No01EthCol01 CAHPS Hospital Survey. Centers for Medicare & Medicaid Services, Baltimore, MD. October 2, 2015. http://www.hcahpsonline.org Chiauzzi, E., Trudeau, K. J., Zacharoff, K., & Bond, K. (2011). Identifying primary care skills and competencies in opioid risk management. Journal Of Continuing Education In The Health Professions, 31(4), 231-240 10p. doi:10.1002/chp.20135 Chlan, L., & Halm, M. A. (2013). DOES MUSIC EASE PAIN AND ANXIETY IN THE CRITICALLY ILL?. American Journal Of Critical Care, 22(6), 528-532 5p. doi:10.4037/ajcc2013998 DewBerry, C. M., & Rose, S. (2010, July). Hospital Medicare reimbursement: Moving to reimbursement based on quality of care. Washington Healthcare News, 5(7), 1-3. Glowacki, D. (2015). Effective Pain Management and Improvements in Patients' Outcomes and Satisfaction. Critical Care Nurse, 35(3), 33-43 11p. doi:10.4037/ccn2015440 Goodman, T. (2015). Every Nurse Can Provide Effective Pain Management. AORN Journal, 101(3), 304-306 3p. doi:10.1016/j.aorn.2015.01.009 Hudspeth, R. S. (2011). Avoiding regulatory complaints when treating chronic pain patients with opioids. Journal Of The American Academy Of Nurse Practitioners, 23(10), 515-520 6p. doi:10.1111/j.1745-7599.2011.00666.x Joint Commission. Management Pain A Systems Approach to Improving Quality and Safety. Joint Commission. Illinois: The Joint Commission on Accreditation of Healthcare Organizations, 2012. Web. 4 Nov. 2015 O'Connor, L. (2013). Understanding individual reactions to opioids in pain management. Nurse Prescribing, 11(5), 233-239 7p.