Changing Practice: The Real Challenge

1. Changing Practice:The Real Challenge

2. Learning does not necessarily = practice change Past experience, attitudes & beliefs Organizational Culture Pain care takes an interdisciplinary approach

3. But the children I cared for always got better without analgesics (or did they)? Research has proven that ineffective pain control increases the risk of pneumonia and blood clots post operatively Children heal faster when pain is controlled (sleep and eat better) Studies suggest that effects of unmanaged pain may not show up until later in life If pain was not controlled how do we know they were OK�did we assess their pain?

4. But children behave better when their parents are not present Quiet children still may have painful or distressing memories (could be more scared next time) Research found that children want their parents present & parents want to be present during painful procedures Parents are a child�s safe person and therefore the child is comfortable to display his/her displeasure Who are we really making it easier for�children or staff?

5. Learning does not necessarily = practice change Past experience, attitudes & beliefs Organizational barriers Pain care takes an interdisciplinary approach

6. We are short staffed�it takes too much time to assess pain When you do vitals signs you can simply ask do you have pain & how much pain by using a tool Parent can help in assessing pain if we teach them to use a validated pain tool Children who are not in pain get better quicker Children who have less pain cooperate more and take less nursing time

7. Distraction�We don�t have time or resources Give written instructions to parents Parents can be the coach (free up the nurse to concentrate on the procedure) Have school children paint or draw pictures to put in procedure rooms Ask parents to bring in books or toys that interest their child Distract adolescents with non procedural talk

8. But the policy says we cannot do that here? Many policies are outdated Who rights the policy? Are they knowledgeable? Misguided belief that opioid infusions= 1:1 nurse:patient ratio (depends on equipment) Pain relief is a standard of care and a human right so we must provide pain care

9. Learning does not necessarily = practice change Past experience, attitudes & beliefs Organizational barriers Pain care takes an interdisciplinary approach

10. But the doctor only orders the medication prn What does prn really mean�when necessary. Nurses can assess the child and determine that it is necessary to give the medication around the clock Request that physicians order scheduled analgesics�more steady state of pain control Educate parents about the benefits of regular analgesics

11. Regular assessment�how often? When admitted Beginning of every shift and throughout the shift (usual minimum every 4 hours) Before every analgesic After every analgesic (1 hour post oral medication; 15 minutes post IV medication)

12. But no one else will change Become a pain champion Assess pain in your patients, tell the physicians, document the results Physicians ask nurses and residents about the child�s pain If analgesics ordered prn and the patient has pain give the medications around the clock If acetaminophen and morphine ordered prn give both if needed (they both work on different pain pathways) Educate colleagues�share your knowledge Make links with others who shared your interest and share the work!!!

13. Challenges to Pain Management Lack of formal education for nurses, doctors and pharmacists Unfounded fears of opioids Too busy to assess pain We think we are too busy to assess pain Too busy to give opioids We think we are too busy to give opioids Continued beliefs of myths