1 / 28

MOPAT A new tool for assessing pain in hospice patients who can’t self-report

MOPAT A new tool for assessing pain in hospice patients who can’t self-report. Presenters: Deborah Bortle, MS, BSN, CHPN Joan K. Harrold, MD, MPH, FACP, FAAHPM. Pain Assessment in Hospice Patients. Patients able to self-report Patients not able to self-report How do we it?

jenski
Download Presentation

MOPAT A new tool for assessing pain in hospice patients who can’t self-report

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MOPATA new tool for assessing pain in hospice patients who can’t self-report Presenters: Deborah Bortle, MS, BSN, CHPN Joan K. Harrold, MD, MPH, FACP, FAAHPM

  2. Pain Assessment in Hospice Patients • Patients able to self-report • Patients not able to self-report • How do we it? • What are the challenges? • What do we need?

  3. MOPAT: Multidimensional Objective Pain Assessment Tool • University of Maryland School of Nursing • Preliminary work (McGuire & Reifsnyder, 2004) suggested that at least 2 dimensions of acute pain—behavioral and physiologic—could be assessed in non-communicative palliative care patients. • Goal: to validate the MOPAT and demonstrate its feasibility in a spectrum of palliative care settings when used by both nurses and informal caregivers to assess acute pain in non-communicative patients.

  4. MOPAT • Hospice of Lancaster County • ADC 450-500 • 12 bed IPU, mainly GIP • Second IPU opened, 16 beds, mainly GIP • Research MS/BSN 0.5 FTE • On-site IS manager to enable EMR data collection

  5. MOPAT in Hospice • Remove blood pressure measurements • Not routinely performed, especially at EOL • Could limit future clinical utility • Staff other than nurses • Other caregivers

  6. Study Design • Eligible IPU patients suspected of having pain • Simultaneous MOPAT assessments by Study RN and Staff nurse (RN or LPN) • 1 primary Study RN with 1 back-up • Reassessment following intervention • Timing based on intervention used • Staff MOPAT results documented in EMR • Study MOPAT results not included in patient record • Serial values were used clinically even if not recorded for the study

  7. Inclusions/Exclusions • Inclusion • Adults with evidence of pain and not able to self-report • Exclusions • Non-responsive • Pediatric < 18 years old • RAST < 5 • Any diagnosis of dementia

  8. MOPAT

  9. Recruitment and Education • Hospice decided MOPAT to be used in IPU for all patients • Regardless of patient enrollment in study • Every IPU nurse trained on MOPAT • MOPAT Incorporated into IPU EMR • UMd created a video of case scenarios • Revised for hospice environment • Unit Director volunteered to be patient in video • Researchers and IPU leaders performed consensus ratings prior to use for training

  10. Training • Trained staff over 3 months • 39 RNs and 22 LPNs agreed to participate in study • 1 RN and 1 LPN declined, but still utilized MOPAT • Same instructor for everyone • Out of the IPU for training • Associated color: PURPLE magnets • Included snacks • Thank you gift: MOPAT clipboard • Feedback via fliers when general issues identified

  11. Clinical Utility Assessment • Completed monthly by nurses who volunteered to participate in this arm of study • No additional incentives • Did nurses like the tool? • Would they use the tool?

  12. Patient Enrollment • Project began March 7, 2009 • Nurses had 3-5 months to use before enrollment patient • 50 patients enrolled by December 11, 2009 • Last patient enrolled November 23, 2010 • 21 month enrollment period for 100 patients

  13. Challenges to Enrollment • IPU transfers 5pm-8am and on Saturdays • Opening of new IPU 7 miles away • Reasons not enrolled: • 50% diagnoses included dementia • 22% died prior to study assessment • 20% died before re-assessment • 2% study nurse not available • 2% RAST < 5

  14. Results: Nurses using MOPAT

  15. Results: Return Rate CUQ’s (%)

  16. Results of MOPAT in Hospice • Reliability • Agreement between Study nurse and Staff Nurse raters was significant at p<.001, with moderate-substantial agreement on most indicators. • Validity • Validity was evidenced by statistically significant (p<.001) reductions in behavioral, physiologic, and total MOPAT scores following pain interventions.

  17. Clinical Utility Questionnaire

  18. Guided pain assessment Assisted in communication Helped determine if pain present Helped determine intervention needed 63.9% 61.1% 61.6% 60.3% Results: Utility

  19. Results: Ease of Use • Reasonable time to complete 63.8% • Easy to use 71.5% • Feasible for regular use 57.3% • Easy to understand 71.8%

  20. Adjustments to MOPAT • Eliminate diaphoresis on MOPAT tool • Added no value • Shortened time to complete

  21. Home Hospice Roll-out • Roll out to admission team first • Tried to get their feedback before HH roll out • Easier to use than they expected • Liked an objective tool • Didn’t like having another form to complete • Recognized need for standardized tool for patients with dementia who cannot self-report • Dementia in IPU accounted for 50% of those excluded from MOPAT study • PAINAD added to EMR prior to HH roll-out

  22. Home Hospice Training • Power point presentation in IDT plus make-up sessions • All IDT members included • Written case scenarios for selection of appropriate tool • MOPAT and PAINAD tools in handouts • Flow chart on how to document your pain assessment • Self report—if unable, choose either… • PAINAD • MOPAT

  23. Issues in Home Hospice • Nurses using assessment tools interchangeably • Even for same patient • More than expected from fluctuations in clinical status • Using self-report while awake and MOPAT while asleep • Using MOPAT and PAINAD for same patient • Nurses only using a tool after they determine patient has pain • Need to use to help determine if a patient has pain • Allows next clinician to compare pain levels using same variables • Communication, not clinical accuracy

  24. Issues in Home Hospice • Definition of dementia • 34.8% with dementia had a MOPAT completed • Emphasize self-report first! • What constitutes a diagnosis of dementia? • Problem or dx list? Family report? Clinical notes? • Timing of focus on NQF #0209 • Comfort in 48 hours • Self-report only • Diminished focus on assessment of patients who cannot self-report

  25. Lessons Learned • Roll-out with fanfare • Need excitement to make an impression • Don’t roll-out with too many other new things • Use the video scenarios in all training • Ask for feedback • Can use the CUQ, but not every month! • Deliver rapid feedback to teams on MOPAT use • Develop organizational policy regarding dementia diagnosis

  26. Future Directions • Use CUQ’s to get nursing feedback in Home Hospice • Beginning January 2013 • Explore use by other caregivers • Nursing home clinicians • Caregivers at home • CUQ: MOPAT could be used by informal caregivers • 1.9% disagree • 39.8% undecided • 58.2% agree

  27. Appreciation to Our Colleagues • Deborah McGuire, PhD, RN, FAAN • Principal investigator • Karen Kaiser, PhD, RN-BC, AOCN • Karen Soeken, PhD • JoAnne Reifsnyder, PhD, ACHPN

More Related