Improving Pain and Symptom Management Specialist Palliative Care Team (SPCT)

About Our Project Symptom control of pain accounts for over 70% of request for SPCT assistance No uniform approach to pain from both ward teams as well as SPCT What tools are currently being used within DBTHFT and how effective are they Finding a tool that would work for all types of patients and diagnosis as well as within any setting

Topic Area Covered Improving pain and symptom management Improving communication on handover from hospital to community Enabling choice and shared decision making on treatment options Improving future care planning in out patients

What are our Aims? Establish a pain assessment tool (CQC evaluation) Education and training on symptom management Incorporating Pain Management Diary in to ‘Me and My Plan’ Empowering patients and relatives to understand their own symptoms and their management to facilitate a smooth transition irrespective of care setting.

Who did the project involve? SPC team Graphics Patients/family Clinical records committee Patient safety review group

What we did? Electronic system review (DBTHFT) of tools currently used Face to face discussions with medics/nursing team regarding ‘their favoured tools’ Systematic literature review of pain tools – cancer and non-cancer Identification of ‘1 tool for all’ Electron discussions with Defense & Veterans Center for Integrative Pain Management (DVCIPM)

What we did? Permission to use the tool and registration with DVCIPM Systemic literature review of pain diaries Devising what the document would look like and sizing Clinical Records Committee Graphics team Patient Safety Review Group – shown to patients/families Graphics Diary produced

Setting/Population Initially a small number of patients/families to be given diary (as may need more changes based on their use) All SPCT patients with DBTHFT inpatients who have an identified need for pain control It is hoped eventually to be used in Out Patient Clinics

Resources Required Input from Graphics team to produce the finished document Comments from reader group Input from service user and team Time ! Negotiation !!! What was needed How did you obtain the resources Patient involvement

Instructions and information   Breakthrough pain diary How to use this breakthrough pain diary Name of patient Keyworker Write down the time and date of each breakthrough pain episode. Fill in all of the sections to capture as much information as possible about the pain experience. This information will help the doctor or nurse decide the best and most effective treatment pathway. If you are using this diary to record for a patient who is unable to verbalise their pain from your expertise of looking after this patient please estimate what you feel the level of pain and expressions that they are experiencing. What is breakthrough pain? People who experience regular pain that is ongoing and continuous, it is called “background pain” and is treated with regular pain medication. Some people may also experience periods of particularly severe and intense pain, this is known as “breakthrough” pain because it breaks through the underlying pain control. This pain usually: Comes on very quickly Is intense and severe, “breaking through” the regular background pain medication Often lasts up to 30 minutes, but often can be longer Can be both predictable (eg. Mobilising) or unpredictable (eg coughing) Is not controlled by the normal background pain medication Use this pain diary to keep a record of any breakthrough pain to discuss on the next visit from the Specialist Palliative Care Team. ** If you feel that the pain is so severe and are requiring lots of extra breakthrough medication then please discuss this with your ward medical team and they will address the needs and liaise with the Specialist Palliative Care Team and we will endeavour to visit you as soon as is possible. Site of pain How it feels Pain score Pain Trigger Name of medication Post medication pain score Notes Where the pain is (eg. Back, head) Chose one of the facial expressions which closely resemble how you/they appear to be feeling Looking at the 0-10 scale and the effect that the pain has, choose the one which closely resembles how much impact the pain is having What were you/they doing when the pain started – even if you/they were asleep Ask the person who is giving the breakthrough pain relief what medication they are giving (if you do not know already) Record what difference, if any the medication received made to the pain For you to write in any comments around the pain episode that you think may need to be discussed at your next assessment , if you are a carer please sign to say that you have made the assessment

Patient Pain Assessment Diary Date and time Site of pain and how it feels (a-f) and pain score (1-10) before receiving medication What triggered the pain? What time did you ask for medication (24hr clock) What time did you receive the medication Name of medication given? What is your pain score 1 hour after receiving the medication (a-f and 1-10)   Notes AFFIX LABEL HERE IF AVAILABLE NHS Number : …………………………………… District Number: …………………………………… Surname: ...................................... Forename(s): …………………………………… Address: …………………………………… ……………………………………………………………….. D.O.B: …………………………………………

Where are we now Tools are completed Awaiting Graphics Awaiting reader group Good feedback from all that have seen it Motivated to role it out Just waiting!!!!

Impact and Evidence Motivation Capacity to continue with project Protocols on introducing new documentation and time scales this involves Continuity of support systems Time scales This is main challenge of where we are currently upto

Key Messages Establish what systems and processes that your trust have when introducing a new document Everything does not have to be perfect or have ‘the finished product’ before getting input from others Finding the time to keep on top of other teams

Any Questions?