Pain Service BHSCT Sr Liz Matthews MSc Advanced Nurse Practitioner Pain Management

The importance of pain Acute/chronic/palliative pain all associated with physical, psychological, emotional & social components. Important economically as requires medical/ surgical and pharmacological costs. NHS needs to ensure availability & accessibility for relief of pain against financial constraints.

Context 2010 – acute & chronic pain service brought under one umbrella Specialist nurses supported to develop practice 6 nurses independent prescribers. 2 complete in May Cross site working, reflective learning and working in partnership to develop roles.

Episodes of care per annum – Acute Pain 4 acute pain services – RVH, MPH, BCH, MIH Total no pts assessed = 6152 Total no assessments = 12,921 Emergency pain calls = 254 Non-surgical pain patients = 146

Access to services – Acute Pain Service Average length of pain care days = 2.9 Average number of interventions = 2.8/pt

Episodes of care – Chronic Pain Nurse led clinics – Knockbreda Health and Wellbeing Centre Total no New pts = 524 Total no Review pts = 1143 Total no Telephone review pts = 766 Ad hoc telephone contact = 800

Access to services – Chronic Pain Service Average time in clinic New patients = 35.5mins/pt Average time in clinic review patients = 25.5mins/pt Average time for telephone review = 15mins/pt

Improved patient experience Nurses provide: Timely access to pain services Source of expert knowledge for all who experience acute/chronic pain Education on pain conditions, daily management and treatments Direct route for advice, management & reassurance Timely admission for treatments TENs & acupuncture clinics

Achievement of service objectives Six monthly audit APS (Epi, PCA, LA, TAP, intra opioids). Ad hoc MDT audit of APS (e.g. thoracic, ortho, older people). Attendance and Outcomes of CPN Led Pain Clinics (6 monthly) Outcome of CPN Telephone Review Clinics (6 monthly). Outcome of Adhoc CPN Telephone Consultations (6 monthly). Patient satisfaction of APS (annually) Patient Satisfaction Survey with Nurse Telephone Review Clinics (annually). Patient Satisfaction with attending outpatient chronic pain clinics (annually). Audit of Access and Referral Criteria Adherence (annually). MYMOPs (an outcome assessment tool measuring benefit of acupuncture) (annually).

Achievement of service objectives Acute/chronic Enhanced patient access, more time spent with patients, individualized experience & journey. Fully utilize the expert knowledge, skill and experience of team members. Chronic Nurse-led conservative management pathway decreases waiting time for initial consultation, treatment and review, achieving the targets laid down by DHSSPS.

Quality of life – Patient comments ‘I live 60 miles from Belfast - with telephone review I have no journey to make’ ‘Good advice on drugs and how they work’ ‘Told about more possible treatments’ ‘Delighted to have a review without leaving home’ ‘Many thanks for all the help and advice I have received’ ‘I'm really grateful to you for listening and explaining about my pain and medications’ ‘I am able to continue at work, no need to cancel appointments or take time off work’ ‘More info today than I've had in all the years I have been attending clinics’ ‘Feel more informed and happier about my future’

Thank you Sr Liz Matthews (chronic) Sr Olga O’Neill (acute) Dr Donna Brown