The education this edition of valuable insights by our in-house hospice & palliative professionals covers the following CAHPS survey question:
While your family member was in hospice care, did the patient get as much help with pain as needed?
The potential answers for this question are:
The answer you want your agency to get is ALWAYS.
Compare your agency to the National & state averages:
Failure to consistently deal with pain is a hospice care fail.
I can’t wake up one day and say, ‘Gosh, I’d like to stay home and have an aide come bathe me and a volunteer pop by to play music for me just because I feel like it.’ Hospice care is first & foremost a form of medical care. Hospice is specialized healthcare and like many specialties in the field of medicine you need an order from a physician to provide hospice care.
You don’t need a physician’s order to provide butterfly ceremonies or volunteer with the elderly. You don’t need a physician’s order to go through a facility and offer spiritual or social support services.
You need a physician’s order to provide healthcare.
The most important piece of hospice healthcare is pain management. If you are not succeeding at delivering pain management, you are not delivering quality hospice care. It would be like an MRI lab that provides great coffee, but half their scans are regularly unreadable.
4 Tips to improve
1. Reorient your team with a priority focus on healthcare
- Train every member of your team that interacts with patient to treat patients’ pain as a problem that must be dealt with immediately!
- Non-clinical staff: Educate your non-clinical staff to ask patients & caregivers if they are in pain and obtain a pain level. Train them to make pain their priority by letting their patients know that even though they’re not nurses, they can take pain reports and can facilitate arranging clinical help for pain management.
- Don’t wait for IDG or rely on a static care plan or scheduled clinical visits. Prioritize patients that are in pain.
- Follow up with patients & caregivers after implementing pain regimens and ensure that the pain treatment is working effectively.
- Always reinforce the 24/7 availability & the importance of communication. Educate patients and caregivers to call and report pain or any uncontrolled symptoms and that many solutions are available with a phone call.
- If you receive reports of pain for one of your patients, follow up with this quickly and attempt to resolve this pain either on the phone or by a visit.
2. Create a process
- It’s easy for nurses to respond to breakthrough pain in the moment during a scheduled visit. What about your chaplains, social workers, aides, volunteers, and other non-clinicians who are interacting with patients or caregivers? Create a process for non-clinicians to report pain as well as a process in place to prioritize pain complaints.
- The process must be more robust than sending a note/text or calling the nurse and hoping the pain report gets dealt with. However, the process must not delay treatment. Often in healthcare there is a tension between documentation and treatment. The process can run on two simultaneous tracks. Non-clinicians should contact the patient’s nurse, DCS or other clinical point person who can deliver an immediate impact on the patient’s pain while also documenting the patient/caregiver pain report.
- Feed the pain report and treatment into a patient care plan. Developing this process ensures that care plans are updated in a timely fashion. Updating care plans are especially important as 7 Of the top 10 survey deficiencies are related to individualized plans of care. CMS Top Ten Survey Deficiencies Compliance Tip Sheet.
Check out how Hospice Tools delivers dynamic smart care plans with a built-in library of suggestions for goals & interventions and links care plans to visit notes for easy & timely updates.
3. Remember, pain is not always visible
- Patients with chronic pain often do not appear to be experiencing pain the way we would think. Chronic pain sufferers become used to pain and can often function and perform daily tasks that would put a person new to pain in the hospital screaming for morphine.
- Believe patient’s report of pain and treat their pain based on their current assessment. Do not cast value judgment or decide if a pain report is “right”. Non-clinicians should accept the pain report and then send that information to the relevant people and through the pain reporting process.
- Medical treatment must be the first line of action. Especially for non-clinicians who cannot provide medical treatment, it is important that they learn to take pain reports and let the patient or caregiver know that they are immediately processing that report through clinical channels. If they have to ability to provide non-clinical pain relief, breathing, meditation, holistic treatments, etc., they must stress that these are secondary and temporary by nature. A short script may help, something like:
“I’ve reported your pain and the nurse will reach out shortly to help get your pain under control. In the meantime, while I’m here with you, let’s try a breathing exercise that may help a bit until the nurse gets here/calls back.”
4. Pain isn’t always physical
Psychosocial/emotional and spiritual pain can be as devastating as physical pain.
Psychosocial/emotional and spiritual pain can make physical pain worse and can limit the effectiveness of a pain management treatment.
In the same vein that a non-clinician must be educated to take a pain report, clinicians must be educated to look for/take a psychosocial/emotional and spiritual pain report.
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