1. Background and Significance
Development of a Specialized Pain Management Program in a Rural Community
Bryan Hunter, DNP, CRNA, NSPM-C ● Matthew Stokes, DNP, CRNA, NSPM-C ● John Maye, PhD, CRNA, CAPT (ret) USN
University of South Florida, College of Nursing
Introduction
Background and Significance
Methodology
Results
In order to improve access to care in rural communities for specialized pain management services the CRNA has emerged through leadership and preparation to fill this critical need. Post-Graduate Advanced Pain Management Fellowships now exist that assist the CRNA in securing the didactic and clinical expertise required.
Rural CRNAs are uniquely positioned to address chronic pain in rural populations
Pain Fellowships are available for CRNAs
Board certification in Pain Management is available to CRNAs
Formal guidance or recommendations for the development of CRNA led pain programs are nonexistent
Development of these programs are complex and fraught with challenges.
To date, the literature is void of information providing guidance to those who are interested in pursuing this challenge.
This initiative is the first formal attempt at providing structure and guidance to those rural CRNAs who desire to provide these services.
Implementation Plan
Guidebook Dissemination
Initial limited Printing
Courtesy Copies presented to established CRNA pain providers for evaluation and input
Revised Guidebook final printing
Publication and ISBN assignment
Guidebook Promotion
Professional organizations (AANA)
Academic Institutions
Social Media
Made available for purchase through online retailers
Simulation-Based Academic Fellowship in Advanced Pain Management
Advanced certifications are an essential component to establish credibility and document expertise in the field. In 2015, The National Board for the Certification and Recertification of Nurse Anesthetists administered the first exam for a newly developed voluntary board certification in advanced pain management. Providers with this credential are designated by “NSPM-C”, which stands for “Nonsurgical Pain Management Certified”.
Discussion
Results
An increased number of CRNAs are venturing into the field of specialized pain management.
Board certified, pain management CRNAs lack a clear and concise methodological approaches for initiating and maintaining successful pain management programs in a rural environment.
The final product produced by this project integrates all relevant information into a clear and concise guidebook to assist the chronic pain CRNA with initial practice development and also ongoing practice evaluation.
Guidebook
Table of Contents
Rural, board-certified CRNAs are uniquely positioned to provide specialized pain management services in areas that have traditionally lacked specialized healthcare providers.
Fellowships in pain management, along with rigorous board certification, ensure competent, high-quality care.
Board certified, pain management CRNAs continue to lack a clear and concise methodological approach for initiating and maintaining a successful pain management program in a rural environment.
Preface
Introduction
Section 1 - Getting Started
Chapter 1 - Overview of a rural pain practice
Chapter 2 - Education, Training & Credentialing
Chapter 3 - Institutional & Community Support
Section 2 - Infrastructure
Chapter 4 - Collaborative Care: The Integrative Pain Management Team
Chapter 5 - Personnel
Chapter 6 - Informatics
Chapter 7 - Equipment
Section 3 - Special Considerations
Chapter 8 - Financial: Insurance & Billing
Chapter 9 - Market Analysis
Chapter 10 - Measurable Outcomes as Quality Indicators
Appendix A - Equipment List
Appendix B - Sample Dictation Notes
Appendix C - Sample Patient Forms
Appendix D - Revised Oswestry Disability Index
References
Methodology
Critical appraisal of existing literature
A Review of Existing Information Obtained from the Development of a New Pain Management Practice in a Rural Community.
Institutional Support
Community Support and Advertising
Analysis of community demographics
Education, Credentialing and Training
Financial/Insurance Issues
Market Competition
Market Share Analysis
Determination of Measurable outcomes
Development of Implementation plan that will assist rural CRNAs with understanding and implementing the critical components necessary for development of a specialized pain management program
Acknowledgements
We would like to thank Dr. John Maye for his unending support and mentorship. Dr. Maye has been a pioneer for CRNA led pain management.
Purpose .
The primary objective of this program development initiative was to develop a guidebook which provides the fellowship trained nurse anesthetist with a methodological approach for initiating and maintaining a successful specialized pain management program in a rural environment.
References
References available upon request.