Pain Management in Hospice Care
Pain is one of the sources of discomfort for the patients admitted in hospice care. Motivated by the need to rectify the paucity of information on the characteristics of pain for the patients who have other terminal diseases other than cancer, Romem et al., (2015) performed a retrospective study in which they wanted to compared the characteristics of pain for those patients admitted for dementia treatment and those with chronic obstructive pulmonary disease (COPD) with those admitted for cancer. Romem et al., (2015) found that there was a high prevalence of pain as a source of discomfort for patients diagnosed with those diseases.
Romem et al., (2015) also found that the physicians in the hospitals managed to control the pain for the patients in the different groups within the first 24 hours in less than 50% regardless of the diagnostic group. Romem et al., (2015) also found that the patients diagnosed with chronic obstructive pulmonary disease complained of pain more than the other diagnostic groups. Another study by Kelly, Bender, Harris & Casarett (2014) found that out of 4157 patients who were assessed for pain, 1992 of the patients reported experiencing pain. Kelly et al., (2015) 1152 patients, which represents 58%, reported that their pain was controlled
The considered change plan to enhance the pain management of the hospice patients is the education of the medical staff. This change plan is supported by Marx (2007) who finds that educating the lower or new officers on the approaches to pain management, the safe administration of drugs meant for pain management, and the drugs that are used to improve the comfort of the patients (Wang et al., 2016).
Change Plan Practice Question
Practice Question
The practice question upon which this paper is bases is whether education can help keep hospitalized hospice patients pain under control. This is because the staff in the medical surgical telemetry was not prepared for hospice care, and the transformation of the floor into a hospice floor has left the staff short-handed.
Defining the Scope of the Practice Question
The practice question is related to the pain management of the hospice patients in the medical surgical telemetry floor. Since the transformation of the floor into a hospice floor, the pain management of the patients is important for the comfort of the patients in under hospice care
Responsibility for Leadership
The implementation of the change plan requires a leader to spearhead to efforts that are required to oversee the change. The facilitation of the implementation process will be tasked to the head physician in the new hospice floor. The hospice physicians are tasked with educating the other medical staff working in the hospice floor on pain management. Marx (2007) also recommends that the physicians have an inevitable role in the education of the other medical staff on pain management in hospice care.
Recruit and Interdisciplinary Team
Interdisciplinary collaboration is important for the implementation of the change plan. Besides the physicians in the hospice floor, other medical staff is required in implementation of the change plan. Some of the other members of the interdisciplinary team that are to be recruited in the healthcare team include the nurses who are assigned to work on the floor. The other staff to be recruited in the team includes the pharmacists who dispense the drugs to be used in pain management.
Scheduling a Team Conference
Scheduling a conference of the team members is necessary to enhance the communication between members and the team leader. During the conference, the leader can share the vision of the change plan. This allows the members to brainstorm ideas and make group decisions.
Evidence
Internal and External Evidence Search
Both internal and external evidence is required to support the implementation of the change plan. The internal evidence to be collected includes the competencies of the medical staff with regards to pain management, the patient surveys from the hospice floor detailing the needs of the patients for pain management, the data on the satisfaction o the patients with regards to pain management, and the data on quality improvement. The external evidence required includes the success of this approach in enhancing pain management.
Appraisal of Evidence
Existing evidence shows that pain management is most effective within 48 hours of admission into the hospice floor Romem et al., (2015). Romem et al., (2015) also found that pain management is achieved in less than 50% of the non-cancer patients. Kelly et al., (2014) also found that 58% reported that their pain was controlled adequately.
Summarize Evidence
The evidence shows that there are opportunities for improvement in the pain management of hospice patients. These opportunities can be exploited through the use of education by physicians.
Rating the Strength of the Evidence
The strength of the evidence will be determined by the team. However, the fact that the evidence is based on empirical data using sound research methodologies speaks for its strength.
Recommendations for Change
The evidence considered shows that there are opportunities for practice change. However, the recommended change entails the education of the medical personnel in the hospice floor to enhance the competencies in pain management (Newhouse et al., 2007).
Translation
Feasibility of implementation
The decision on the feasibility of the implementation is to be made in consulting with the entire organization. This is because the implementation of the change will result in effects that affect the entire organization (Newhouse et al., 2007).
Creating an action plan
The action plan entails the guidelines, the protocols, and the critical pathways to track the implementation of the change (Newhouse et al., 2007).
Implementation of the Change
The changes will be implemented throughout the floor. The stakeholders will be informed on the progress of the implementation process through progress reports (Newhouse et al., 2007).
Evaluation of the Outcomes
The evaluation will be done against the expected outcomes. The evaluation of the success of the implementation process will be done by the team. The evaluation will highlight the changes that may be required (Newhouse et al., 2007).
Besides the physicians, nurses and the clinical officers, the office administration also has an interest in the results of the project. The reports that are developed from the evaluation phase will be submitted to the hospital administration for review (Newhouse et al., 2007).
Soliciting Support for Implementation of Recommendations
Depending on the feasibility of implementation, the team will solicit the hospital administration for financial, human, and material support for the implementation of the change (Newhouse et al., 2007).
Identification of the Next Steps
This entails the determination of the necessary steps considering the stage of the project (Newhouse et al., 2007).
Communicating the Findings
This entails the dissemination of the findings of the project. The communication of the findings is not just limited to within the organizations but to external organizations through professional journals (Newhouse et al., 2007).
Summary
The various parts above highlight the different steps in the implementation of a change in response to a problem in the hospice floor. The implementation of the program is dependent on the feasibility studies and the support of the entire organization. The change is maintained by ensuring that all the stakeholders are on board, and through periodic monitoring and evaluation.
References
Kelly, L., Bender, L., Harris, P. and Casarett, D. (2014). The "comfortable dying" measure: how patient characteristics affect hospice pain management quality scores. Journal of Palliative Medicine. 17(6):721-724.
Marx, T. (2007). Working With Hospice Teams to Improve Pain Management in Nursing Homes. The Journal of the American Osteopathic Association. 107: ES22-ES27
Newhouse, R., Dearholt, S., Poe, S., Pugh, L. and White, K. (2007). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Indianapolis. Sigma Theta Tau International.
Romem, A., Tom, S., Beauchene, M., Babington, L., Scharf, S. and Romem, A. (2015). Pain management at the end of life: A comparative study of cancer, dementia, and chronic obstructive pulmonary disease patients. Palliative Medicine. 29(5): 464-469.
Wang, J., Wu., C., Hwang, I., Kao, C., Hung, Y., Hwang, S. and Li, C. (2016). How different is the care of terminal pancreatic cancer patients in inpatient palliative care units and acute hospital wards? A nationwide population-based study. BMC Palliative Care, 15:1
