1. Common Language Tool Kit
Common Language Tool Kit – why do we need it? A Common Language Toolkit was utilized to provide consistent education to each RN and NA on the unit. This education focused on using common messages to discuss pain that encouraged dialogue, addressed patient fears and empowered RNs to identify themselves as pain experts.
Molly McNaughton, MSN, RN, CNP
Abbott Northwestern Hospital, Pain Team
September 22nd, 2017

2. DISCLOSURE
I certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting. 1

3. Why do we need a common language?
To acknowledge our patient’s pain and demonstrate partnership with them in our response
Objective

4. Establish Trust and Partner with Patients

5. How do we show compassion and empathy?

6. I am sorry that you are having a lot of pain.
We will work together to manage your pain and keep you as comfortable as possible.
What should I know about your pain?

7. Meet Patients Where they are at…
If you can’t give me a pain number, could you describe an image of your pain?
Tell me about your pain in your own words?
achey
stabbing
dull
Can you compare this to another painful event?
(injury, accident, previous surgery)

8. Collaborate with patients
Offer choices for pain management (use the comfort menu)
Set a realistic pain goal
We expect you to have some pain, tell me a number where the expected pain would be tolerable for you?

9. a.k.a Share your expertise
Partner with your patient
a.k.a Share your expertise
Pain is a sign of healing, so you can expect some pain, however we do want to keep you comfortable as you heal
In my experience, patients who have had this diagnosis can expect...
When I have taken care of other patients with your diagnosis, they feel better when we …
What do you want to be doing that your pain is preventing you from doing?

10. What does your patient know about pain?
Assessing the Patient’s knowledge of pain and their expectations of pain
What does your patient know about pain?

12. What does your patient know about pain?
Did they expect to have pain?
What prior experiences have they had with pain?
Knowing where they are at helps you to set appropriate treatment goals

13. Create a Pain Plan in the Problem list
Pain goal:
Livable at 6/10
Pain plan:
Prescribed Percocet 5/325 #90 per month. Adjunct: uses ice packs, PT home exercise plan.
Recommend follow-up with provider if pain is not controlled.

14. Why am I asking you about pain all the time?

15. YOUR FEEDBACK
MATTERS
Ask Art about his experiences
Because without feedback, we are not able to partner with patients to manage pain effectively

16. Pain Scales and how to use them
What is the purpose of a pain scale?

17. Gives your patient a tool to describe their pain

18. Pain can be described as a word, number, face.

19. A Number

20. Pain can be described as a word, number, face.

21. Look to function

22. Modified VAS Pain Scale
Provides numbers with subjective and objective symptoms.
This can help patients and caregivers communicate about pain and share a common understanding of the level of pain the patient is experiencing.
A new version of the VAS pain scale with functional descriptions of pain was implemented system wide to encourage dialogue between providers and patients and improve the accuracy of reported scores.

23. “My Pain is Severe” 10 5 8
“I’m glad we all agree” PT
Patient RN

24. What does Severe mean?
Oh… PT
Patient RN

25. Using tools to find a shared understanding
I can’t concentrate and I can’t go to the bathroom without help PT
Patient RN

26. Demonstrates empathy and commitment to providing compassionate care6 6 6
“I’m glad we all agree” PT
Patient RN

27. Pain management and comfort interventions

28. Use language that acknowledges pain
We will work together as a team to help you Our goal is to find what works best for you
Use a collaborative approach:

29. Recommend Treatment Options
Remember, you are the expert
“Sometimes medications can be helpful in managing your pain”
“Many comfort measures can ease pain on their own or help the medications work better”

30. Comfort Menu Handout with options to improve comfort Medications
Relaxation
comfort actions
comfort items
distractions

32. Managing pain at discharge
What is your “exit” strategy?

33. Pain Medications prior to Discharge
Teach patients that proactive pain management helps to speed recovery and may lessen the time that they need to take pain medication.
Discuss that you are working to create a pain plan in the hospital that they can follow at home.
Communicate plan for pain medication transition with the patient during beside shift handover.
Talk about medications and interventions that are working. Then talk about what is not working.

34. Pain Medications at Discharge
Most Common Side Effects and how to manage them
Sedation
Try taking less, decrease the dose and increase the time between doses
If appropriate, alternate with Tylenol
Constipation
Keep hydrated with water
Take bowel medications as prescribed
High fiber foods if appropriate
Nausea
Take medications with food or milk
If intolerable, call your provider

35. Pain Medications at Home
Keep track of when you take a pain medication and how much you took.
Use the grid provided on the AVS to document medications
Educate patients that they should see a trend of less medication every day as they recover and heal.
If patients are struggling with pain control or side effects at home, they should call their surgeon or primary care provider.
Shared decision making tool

36. Verbal and Non-verbal communication

37. Verbal Communication Instead of saying… Try this instead…
You can’t have anything else
Here are some options you have to help you get more comfortable
What did you expect, you had a painful procedure?
I’m sorry you are hurting, you had a painful procedure.
Labeling a patient a “drug abuser” or addict
I am an expert in pain and will work with you to manage your pain.
Your doctor did not order anything else for you.
Is your pain tolerable? Is your pain control acceptable?
You shouldn’t be so painful
What should I know about your pain? Tell me about your pain.
You will have to wait, I have other patients to see first.
I know you have been waiting, but I wanted to be sure I had enough time to really listen to you.
What do you want me to do?
What has helped you in the past?

38. Non-Verbal Communication Don’ts
Crossing your arms Getting distracted

39. Non-Verbal Communication Don’ts
Negative Facial Expressions

40. Non-Verbal Communication Wins
Position yourself towards your patient
Sitting is powerful. It conveys the message that you are not in a hurry and puts you on the same level as your patient.

41. Non-Verbal Communication Wins
Smile and breathe before you enter a room.
New patient, new situation. Try to reset every time you start a new encounter.

42. Non-Verbal Communication Wins
When you need help, bring in your team.
This demonstrates your commitment to care.
Art – talk about PT and MD collaboration

43. CONCLUSION

44. Common Language Tool Kit – why do we need it
Common Language Tool Kit – why do we need it? A Common Language Toolkit was utilized to provide consistent education to each RN and NA on the unit. This education focused on using common messages to discuss pain that encouraged dialogue, addressed patient fears and empowered RNs to identify themselves as pain experts.
Patients want to be defined as a distinct person, etching their memory into the memory of their caregivers
Our Challenge

45. REFERENCES
2ND TO LAST PAGE

46. TO CONTACT ME Molly McNaughton, CNP
Chronic Pain Team • ANW • Tuesday-Friday
Phone: • Pager: • Cell:
Mail Route • 800 East 28th Street, Minneapolis, MN