Pain and the Pathways Program

Creating a Pain Initiative

Room 217 Music Care Consultant

USA

CMS LTC Final Rule

November, 2016

Forest Hill Rehab and Skilled Nursing Center

Peter Sirois

Chief Executive Officer

Northern Maine Medical Center

Northern Maine Medical Center

Fort KentMaine

Travis Guy-RN

Director-Forest Hill

Music and Memory’s

IpodProject

Data Collection for our Quality

Assurance Performance Improvement

Program.

Alain Bois

Chief Operating

Officer

NMMC

-Executive Director-Director of Nursing-Activities Director-Dietary Director-Music Care Director-Minimum Data Set Coordinator

DepressionInitiative Team

- Chief Operating Officer- Executive Director- Director of Nursing- Music Care Consultant- Minimum Data Set Coordinator- Charge Nurse- Two RN’s

Pain Initiative Team

Bev Foster-Executive

Director of The Room 217

Foundation

24 evidence based studies

A review of the literature.

Project Charter

Name of project- Resident who self-report moderate to severe pain.

Problem to be solved- Despite staff efforts, residents with self-reporting of moderate to severe pain is a notable challenge for FH. A higher turnover in staffing including recent changes with leadership have made it more difficult to solidify best practices when related to pain management.

Goals for this project-FH will demonstrate a score of 12% on the CASPER Report in regards to percentage of long-term care residents who self report moderate to severe pain in 12 months.

Staff education- 1:1 100%

Scope- Best practices in addition to music care activities will be instated in our culture to address reduction in pain.

Barriers-New initiative not engrained in the culture, lack of staff education, staff does not adhere to the process developed to improve outcomes.

Solutions-Observation and feedback, provide education.

Project Time Table- 12 months

Measure of Success- FH will demonstrate a score of 12% on the CASPER Report.

Pathways- Making Connections by Singing

Sensory Room

• Light projection lamp• Crystals Floor Lamp• Aromatherapy

Diffuser• Peppermint and

lavender essential oil• T.V with DVD player• Bubble Lights• Massage Oil• Sensory objects

Music Care

Comfort Cart

• Pathways DVDs• Portable DVD player• Room 217 Recollections

DVDs• Blankets and pillows for

caregivers• C.D Player• Room 217 Complete C.D

Collection• Room 217 Conversation

Cards• May I Walk You Home-

Resource book for caregivers• Aromatherapy diffuser• Lavender essential oil• Massage oil infused with

lavender

MENU

• Music Care

• M Technique Hand Massage

• Aromatherapy

• Sensory Room

• Comedic DVD’s

• Guided Imagery

• Pet Therapy

• Ambulation

• Cold/Hot Compresses

• Warm Blankets

• Crafts

Choosing an item from the menu allows the resident to judge preferred outcomes. This leads to:

- Experience- Validation- Empowerment- Relational

How will I know if

alternative methods to relieve pain

are working?

Improvement in quality of life.

A visible increase in resident, family and staff satisfaction.

Costs are lowered due to decrease in medication usage.

-Improve the patient experience of care-Improve the health of populations-Reduce the per capita cost of health care

Mary-Anne Desjardins RN

Director of Nursing

Forest Hill

Reasons Residents Fail To Report Pain.

#1- They don’t want to bother staff.

#2- They worry if they report pain this could mean a change in pathology.

#3- Concerns arise when illness is accompanied by pain which can represent a loss of function, loss of independence and even loss of life.

Establish Key Performance Measures

• Residents will have a documented pain goal.

• Documented pain scale prior to being medicated or receiving a non-pharmacological intervention.

• Pain will be assessed within 1 hour of medication administration.

• Documented number of residents receiving effective pain relief using either medication or non-pharmacological method.

• Documented pain scale after being medicated or receiving non-pharmacological intervention.

Educate

Staff -0-10 Pain Scale

Staff- Importance of offering non-pharmacological methods.

Residents-Long term effects of pain medications.

Daily Ambulation-What We Know

-Maintains muscle strength-Increases joint flexibility-Stimulates circulation-Relieves pressure on skin-Improves feelings of independence-Creates an opportunity for socialization-Quality of life is enhanced

Changing The Care Experience Using Music-What We Know

-Biological

-Emotional

-Social

-Cognitive

-Spiritual

Music Care Model

Changing the Care Experience

PositiveEmotions

NegativeEmotions

-Increases social engagement-Improves cognitive awareness-Provides an opportunity for reminiscence-Elevates mood-Improves quality of life

Sing a Song

Sharing the

Music Care Experience

The Power of Song

Resident Care Coordinator

Louise BourgoinRN

Pain AssessmentUpon admission to LTC the residents pain goal is established when the Charge nurse does an admission assessment. This information is recorded on the electronic MDS form and the assessments are submitted to CMS. On a scale of 0-10 any pain reported over 5 is considered significant and flagged as moderate/high.

MDS 3.0 CMS Casper5 Star Quality

Administering Pain Medication

• It is important to evaluate both the meaning of the pain, the coping resources which include the perceived effectiveness of coping strategies and the perceived ability to control one’s pain.

• Since the implementation of the Pain Initiative our DON reviews which residents receive daily PRN medications. Those whose pain scores are above 5 are asked to contact their physicians so that medications can be scheduled. This proves beneficial in most cases since some residents will wait until their pain is unbearable before asking for medication. When pain levels are this high pain is difficult to manage.

Questions to Ask

-How did you cope with prior pain experiences while living at home?

-What were your preferred methods for pain management?

-How many times this week were you unable to experience a pleasurable activity because of your pain?

-REMEMBER to routinely assess the impact of pain on the resident’s ability to engage in ADL’s, hobbies, social settings and impact on sleep and appetite.

Pain Interview

• Pain interviews are done when quarterly assessments are due which is every 3 months.

• The MDS 3.0 Nursing Home Comprehensive Section J is the reporting tool used to conduct the Pain Interview.

• Medication lists are evaluated for effectiveness.• If pain in not being controlled the Charge Nurse reaches out to

the provider. Our pharmacist can also do a medication review and make suggestions as necessary.

• It is noted whether or not there are alternative interventions being used by the resident and if they are proving to be effective.

In 5 months Forest Hill has lowered its pain percentage from 28.60% to 15.40%.

A collaborative effort between The Room 217 Foundation, Northern Maine Medical Center

and Forest Hill Rehab and Skilled Nursing Center

Fort Kent, Maine:

The Little Town That Could