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A Quality Initiative Incorporating Tablet Technology to Facilitate Nonpharmacologic Pain Intervention Use in the Hospital

Published:April 08, 2022DOI:https://doi.org/10.1016/j.pmn.2022.02.067

      Highlights

      • Regulatory agencies and professional organizations encourage use of nonpharmacologic pain interventions (NPIs) for multimodal pain management to reduce reliance on opioids. A framework with strategies to incorporate NPIs into hospital settings has not been developed and tested.
      • Nurses are uniquely positioned to integrate NPIs into their patients’ multimodal pain management plan of care through patient and family education and incorporating NPIs as first-line and adjunctive interventions for pain.
      • Utilizing technology, such as MyChart Bedside iPads, can support patient and family education about NPIs and facilitate integration of NPIs into clinical practice.

      Abstract

      Background

      The opioid crisis has changed the culture and expectations of pain management, elevating the importance of nonpharmacologic pain interventions (NPIs) into multimodal pain management programs. Little is known about use of NPIs in hospitalized patients.

      Aims

      This quality improvement project aimed to increase awareness and use of NPIs by engaging patients and nurses on one medical unit using tablet technology.

      Methods

      Pre- and post intervention data were collected using surveys of nurse and nursing assistant perceptions of NPIs and by assessing pain management experiences of acute care patients using the American Pain Society-Pain Outcomes Questionnaire-Revised. Interventions included staff education, integration of an NPI menu and tools onto bedside tablets, and a Comfort Card communication tool.

      Settings

      This Quality Improvement project was conducted on an 18-bed adult medical unit at a Midwestern academic medical center.

      Participants/Subjects

      Subjects included RN and Certified Nursing Assistants from one medical unit. Patient perspectives were obtained from a baseline cohort of 30 hospitalized medical patients and compared to an intervention group of 15 medical patients. Patient inclusion criteria included adults ages 18 and older, hospitalized ≤72 hours, who verbalized a willingness to participate.

      Design

      The 8-week project included nurse and nursing assistant pre-/post-intervention perception surveys and an educational module about NPIs. Pain management experiences and NPI use were assessed post-tablet intervention using the American Pain Society-Pain Outcomes Questionnaire-Revised (APS-POQ-R). Additionally, staff education, integration of an NPI menu and tools onto bedside tablets, and a Comfort Card communication tool were planned interventions.

      Results

      Nursing staff believe NPIs are beneficial, safe, and evidence-based; however, limited resources, time constraints, and lack of provider support are perceived as barriers. Staff and volunteers provided 80 comfort items to 38 patients during the project. Half of baseline patients (n = 30) and intervention (n = 15) groups reported not receiving information about pain treatment options. Many patients in both groups denied using “non medicine methods,” but further assessment revealed that 90% of the baseline group and 87% of the intervention group had used an NPI.

      Conclusions

      Results suggest that patients and nurses may benefit from education about using NPIs in acute care. Nurses have a critical role influencing positive pain-related outcomes, and tablet technology can enhance patient use of NPIs during hospitalization.
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      References

        • Aldekhyyel R.N.
        • Bakker C.J.
        • Pitt M.B.
        • Melton G.B.
        The impact of patient interactive systems on the management of pain in an inpatient hospital setting: A systematic review.
        Applied Clinical Informatics. 2019; 10: 580-596
        • Alenezi A.
        • Yahyouche A.
        • Paudyal V.
        Current status of opioid epidemic in the United Kingdom and strategies for treatment optimisation in chronic pain.
        International Journal of Clinical Pharmacy. 2021; 43: 318-322
        • Bandura A.
        Self-efficacy: Toward a unifying theory of behavioral change.
        Psychological Review. 1977; 84: 191-215
        • Becker W.C.
        • Dorflinger L.
        • Edmond S.N.
        • Islam L.
        • Heapy A.A.
        • Fraenkel L.
        Barriers and facilitators to use of nonpharmacological treatments in chronic pain.
        BMC Family Practice. 2017; 18: 41
        • Bonakdar R.
        • Palanker D.
        • Sweeney M.M.
        Analysis of state insurance coverage for nonpharmacologic treatment of low back pain as recommended by the American College of Physicians Guidelines.
        Global Advances in Health and Medicine. 2019; 82164956119855629
        • Botti M.
        • Khaw D.
        • Jørgensen E.
        • Rasmussen B.
        • Hunter S.
        • Redley B.
        Cross-cultural examination of the structure of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R).
        Journal of Pain. 2015; 16: 727-740
      1. Brandt, K. (2019). New Part D policies address opioid epidemic. Retrieved from: https://www.cms.gov/blog/new-part-d-policies-address-opioid-epidemic

        • Bruckenthal P.
        • Marino M.A.
        • Snelling L.
        Complementary and integrative therapies for persistent pain management in older adults.
        Journal of Gerontological Nursing. 2016; 42: 40-48
        • Bushnell M.C.
        • Čeko M.
        • Low L.A.
        Cognitive and emotional control of pain and its disruption in chronic pain.
        Nature Reviews Neuroscience. 2013; 14: 502-511
      2. Centers for Disease Control and Prevention (CDC). (2016). CDC guideline for prescribing opioids for chronic pain. Retrieved from: https://www.cdc.gov/drugoverdose/pdf/prescribing/Guidelines_Factsheet-a.pdf

      3. Centers for Disease Control and Prevention (CDC). (2021). Understanding the epidemic. Retrieved from: https://www.cdc.gov/opioids/basics/epidemic.html

      4. Centers for Medicare & Medicaid Services (CMS). (2019). Improving drug utilization review controls in Part D. Retrieved from: https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization

        • Chen L.
        • Michalsen A.
        Management of chronic pain using complementary and integrative medicine.
        BMJ. 2017; 357: j1284
      5. Dowell, D. (2016). CDC recommendations for nonopioid treatments in the management of chronic pain clinician outreach and communication activity (COCA) call July 27, 2016. Retrieved from: https://stacks.cdc.gov/view/cdc/43508

        • DeVore J.
        • Clontz A.
        • Dianxu Ren
        • Cairns L.
        • Beach M.
        Improving patient satisfaction with better pain management in hospitalized patients.
        Journal for Nurse Practitioners. 2017; 13e23–e27.https://doi-org.ucsf.idm.oclc.org/10.1016/j.nurpra.2016.07.020
        • Drake G.
        • de C. Williams A.C
        Nursing education interventions for managing acute pain in hospital settings: A systematic review of clinical outcomes and teaching methods.
        Pain Management Nursing. 2017; 18: 3-15
        • Echeverria-Villalobos M.
        • Stoicea N.
        • Todeschini A.B.
        • Fiorda-Diaz J.
        • Uribe A.A.
        • Weaver T.
        • Bergese S.D.
        Enhanced Recovery After Surgery (ERAS).
        The Clinical Journal of Pain. 2020; 36: 219-226
        • Engel G.
        The need for a new medical model: A challenge for biomedicine.
        Science. 1977; 196: 129-136
      6. GRADE Working Group. (2020). Retrieved from: https://www.gradeworkinggroup.org/

        • Gordon D.B.
        • Polomano R.C.
        • Pellino T.A.
        • Turk D.C.
        • McCracken L.M.
        • Sherwood G.
        • Paice J.A.
        • Wallace M.S.
        • Strassels S.A.
        • Farrar J.T.
        Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for quality improvement of pain management in hospitalized adults: Preliminary psychometric evaluation.
        The Journal of Pain. 2010; 11: 1172-1186
        • Hall H.
        • Leach M.
        • Brosnan C.
        • Collins M.
        Nurses’ attitudes towards complementary therapies: A systematic review and meta-synthesis.
        International Journal of Nursing Studies. 2017; 69: 47-56
        • Haun J.N.
        • Ballistrea L.M.
        • Melillo C.
        • Standifer M.
        • Kip K.
        • Paykel J.
        • Murphy J.L.
        • Fletcher C.E.
        • Mitchinson A.
        • Kozak L.
        • Taylor S.L.
        • Glynn S.M.
        • Bair M.
        A mobile and web-based self-directed complementary and integrative health program for veterans and their partners (Mission Reconnect): Protocol for a mixed-methods randomized controlled trial.
        JMIR Research Protocols. 2019; 8: e13666
      7. Institute for Healthcare Improvement. (2021). How to improve. Retrieved from: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx

      8. International Narcotics Control Board (INCB). (2018). Narcotic drugs. Estimated world requirements for 2020. Statistics for 2018. Retrieved from: https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/7_Comments_E.pdf

      9. The Joint Commission (2017). R3 report: Requirement, rationale, reference. A complementary publication of The Joint Commission. Retrieved from: https://jntcm.ae-admin.com/assets/1/6/R3_Report_Issue_11_Pain_Assessment_2_11_19_REV.pdf

      10. The Joint Commission. (2018). New Joint Commission advisory on nonpharmacologic and nonopioid solutions for pain management. Retrieved from: https://www.jointcommission.org/en/resources/news-and-multimedia/news/2018/08/new-joint-commission-advisory-on-nonpharmacologic-and-nonopioid-solutions-for-pain-management/

      11. Kelly, M. M., Hoonakker, P. L. T., Dean, S. M. (2017). Partnering with parents of hospitalized children using an inpatient portal. University of Wisconsin School of Medicine and Public Health Department of Pediatrics, Center for Quality and Productivity Improvement, Institute for Clinical and Translational Research, and UW Health Innovation Program. Retrieved from: https://www.hipxchange.org/Inpatientportal/

        • Labus N.
        • Wilson C.
        • Arena S.
        Mind-body therapies as a therapeutic intervention for pain management.
        Home Healthcare Now. 2019; 37: 293-294
        • Lee S.S.
        Relieving pain in American: A blueprint for transforming prevention, care, education, and research.
        Journal of Pain & Palliative Care Pharmacotherapy. 2012; 26: 197-198
      12. Mahoney, D. (2016). Nurses’ role in improving the pain management culture. Industry edge: A Press Ganey publication. 1-2. Retrieved from: https://www.pressganey.com/blog/nurses'-role-in-improving-the-pain-managementculture#:∼:text=The%20most%20important%20things%20nurses,and%20value%20the%20patient's%20and.

        • McDonall J.
        • Steiger R.
        • Reynolds J.
        • Redley B.
        • Livingston P.M.
        • Hutchinson A.F.
        • Botti M.
        Patient activation intervention to facilitate participation in recovery after total knee replacement (MIME): A cluster randomised crossover trial.
        BMJ Quality & Safety. 2019; 28: 782-792
        • Montgomery R.
        • McNamara S.A.
        Multimodal pain management for enhanced recovery: Reinforcing the shift from traditional pathways through nurse-led interventions.
        AORN Journal. 2016; 104: S9-S16
        • Munkombwe W.M.
        • Petersson K.
        • Elgán C.
        Nurses’ experiences of providing nonpharmacological pain management in palliative care: A qualitative study.
        Journal of Clinical Nursing. 2020; 29: 1643-1652
        • Nahin R.L.
        • Boineau R.
        • Khalsa P.S.
        • Stussman B.J.
        • Weber W.J.
        Evidence-based evaluation of complementary health approaches for pain management in the United States.
        Mayo Clinic Proceedings. 2016; 91: 1292-1306
        • National Center for Complementary and Integrative Health (NCCIH)
        Pain.
        National Institutes of Health website, 2019 (Retrieved from:)
        • Nightingale F.
        Notes on nursing. What it is, and what it is not.
        Harrison, London, England1860
        • Noba L.
        • Rodgers S.
        • Chandler C.
        • Balfour A.
        • Hariharan D.
        • Yip V.S.
        Enhanced recovery after surgery (ERAS) reduces hospital costs and improve clinical outcomes in liver surgery: A systematic review and meta-analysis.
        Journal of Gastrointestinal Surgery. 2020; 24: 918-932
        • Patmon F.L.
        • Gee P.M.
        • Rylee T.L.
        • Readdy N.L.
        Using interactive patient engagement technology in clinical practice: A qualitative assessment of nurses’ perceptions.
        Journal of Medical Internet Research. 2016; 18: e298
        • Perrone J.
        • Weiner S.G.
        • Nelson L.S.
        Stewarding recovery from the opioid crisis through health system initiatives.
        The Western Journal of Emergency Medicine. 2019; 20: 198-202
        • Polomano R.C.
        • Fillman M.
        • Giordano N.A.
        • Vallerand A.H.
        • Nicely K.L.
        • Jungquist C.R.
        Multimodal analgesia for acute postoperative and trauma-related pain.
        The American Journal of Nursing. 2017; 117: S12-S26
        • Roth I.
        • Highfield L.
        • Cuccaro P.
        • Wells R.
        • Misra S.
        • Engebretson J.
        Employing evidence in evaluating complementary therapies: Findings from an ethnography of integrative pain management at a large urban pediatric hospital.
        Journal of Alternative and Complementary Medicine (New York, N.Y.). 2019; 25: S95-S105
        • Tajerian M.
        • Clark J.D.
        Nonpharmacological interventions in targeting pain-related brain plasticity.
        Neural Plasticity. 2017; 2038573
        • Tick H.
        • Nielsen A.
        • Pelletier K.R.
        • Bonakdar R.
        • Simmons S.
        • Glick R.
        • Ratner E.
        • Lemmon R.L.
        • Wayne P.
        • Zador V.
        • Pain Task Force of the Academic Consortium for Integrative Medicine and Health
        Evidence-based nonpharmacologic strategies for comprehensive pain care: The consortium pain task force white paper.
        Explore (New York, N.Y.). 2018; 14: 177-211
        • Vallerand A.H.
        • Crawley J.
        • Pieper B.
        • Templin T.N.
        The perceived control over pain construct and functional status.
        Pain Medicine. 2016; 17: 692-703
        • Vashishtha D.
        • Mittal M.L.
        • Werb D.
        The North American opioid epidemic: Current challenges and a call for treatment as prevention.
        Harm Reduction Journal. 2017; 14: 7
        • Warren C.
        • Jaisankar P.
        • Saneski E.
        • Tenberg A.
        • Scala E.
        Understanding barriers and facilitators to nonpharmacological pain management on adult inpatient units.
        Pain Management Nursing. 2020; 21: 480-487