Benchmarking the Management of Pain

1
Benchmarking the Management of Pain

• Once upon a time

2
Setting the scene.

• Neonates dont feel pain
• Analgesia not safe for neonates / it will
  impair there respiratory effort
• Pain as a therapeutic driver

3
New Quality initiative

• Judith Ellis in 1996 in Preston introduced
  paediatric clinical practice benchmarking
  ?neonatal group
• 34 medical units and 2 surgical units
• First topic chosen PAIN
• Some units had policies, some guidelines and some
  nothing but good will!

4
First Pain Benchmark

• 5 Factors
• Pain Assessment Tools
• Pain assessed and recorded
• Multidisciplinary Protocols
• Appropriate use of Pain relief
• Information

5
First benchmark cont.

• Pain assessment tools split into 4 section
• No pain assessment tool in use
• Pain assessment tool in use for selected babies
  only
• Pain assessment tool in use in Intensive care
  only
• Pain assessment tool used for all babies
• Score from 0-10 very subjective

6
Was it useful?..in so many ways!!!!!

• ?Networking and Sharing practice
• ?MDT liaison and discussion / debate
• ?Validates nursing care in its broadest sense.
• ?Encourages audit / research and the challenging
  of existing and dated practice.
• ?Less isolation, more sharing of resources and
  greater consensus across NW

7
Under scrutiny..

• No assessment tool
• No agreed care pathway
• Conflicting opinions
• Nothing for the surgical procedure
• A lot of work to do

8
First stepsMDT involvement

• Following a literature review of all the existing
  pain assessment tools, Dr Charlton designed a
  pilot study concentrating on what characteristics
  nurses use to define pain / distress.
• Published in Journal of Neonatal Nursing 1999
  2000

9
Nurses involvement

• Formalised our care planning and improved our
  documentation.
• Meetings with Anaesthetists to discuss pilot of
  pain tool
• Literature search and networking with other units

10
New Developments

• Arrival of Essence of Care
• Major review of existing format
• Evidence base
• Need for standardisation to improve consistency.
• Agree a Best Practice Statement
• Agree Indicators of best practice which are SMART
  where ever possible
• Action Plans

11
New Pain Benchmark..impact of Clinical Governance

• Still 5 factors but how different
• Pain assessment- tool must include specific
  criteria
• Management of Pain - holistic
• Equipment and resources MDT
• Staff Education competenceSfBH / NHSLA
• Parental Education and support including ED

12
Delivering a quality service?

• PAT score
• Pain Liaison nurse
• Care plan
• Guidelines for managing pain
• Resources
• Audit

13
Is it worth it?

• Scoring template to prove development year on
  year
• Action Plan to support Business case for
  resources
• Evidence to promote new practice
• Greater emphasis on MDT involvement