Individualized care for pain management

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Pain is a subjective and individual experience, but most people would agree that in any form, it is undesirable and decreases quality of life.

At Runnymede Healthcare Centre, where patients are recovering from and receiving specialized treatment for a combination and variety of conditions such as bone fractures, complex wounds and arthritis, pain can arise as a result of different factors. One patient might experience severe pain from a urinary tract infection, while another might feel slight pain in their joints after exercise in a physiotherapy session.

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“Regardless of the type or level of pain experienced by the patient, our aim is always for all patients to be pain-free,” says Vice President, Clinical Programs, Lisa Dess. “And to ensure every patient at Runnymede receives an individualized plan of care that maximizes their health, our clinical team takes a proactive, preventative approach to pain management that begins the moment a patient arrives at the hospital.”

Upon a patient’s admission, the clinical team performs comprehensive assessments that identify real and potential causes of pain and the interventions needed to reduce and prevent that pain. Pharmacists also complete a medication reconciliation to get the patient’s medication history. This information informs the physician’s prescription of the most suitable medicines, doses and timing that would complement other treatments and would not inhibit their functional ability or rehabilitation at the hospital.

“Front-line staff have a high index of suspicion when assessing patients for possible pain,” says President of Medical Staff, Dr. Kingsley Watts. “Pain manifests in various ways and could be an underlying cause of a number of symptoms and conditions, such as confusion, aggression, social withdrawal, insomnia and depression. Moreover, some patients don’t vocalize their pain and sometimes their pain is not obvious. Taking the time to know patients individually and being in tune with the various ways they might respond to pain—what they say, how they look, how they act—is therefore critical not only for proactive pain management, but to help ensure symptoms arising from pain are not missed.”

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Collaboration and communication between disciplines is also an important aspect of Runnymede’s pain management strategy. This is facilitated by the interdisciplinary team’s weekly rounds, which provide the opportunity to exchange new information regarding the patient’s progress, assess intervention strategies and discuss further possibilities for improvement.

Sometimes an intervention as simple as resting the pain area, using hot and cold packs, dimming the lights in a patient’s room, lowering sound levels in the patient’s environment or encouraging the patient to participate in therapy sessions makes a significant difference. But interventions are always personalized to a patient’s unique needs.

A patient with osteoarthritis, for example, might be treated with dry heat therapy to increase circulation in affected joints and decrease pain. In physiotherapy, that same patient might be encouraged to mobilize the joint and use a range of motion to prevent limb contractures and further joint pain. A patient who has just sustained a stroke and is at risk of painful flexion contractures in their wrists and fingers (a shortening of muscle tissue and tendons, forcing the joint into a flexed position), might be given a splint to correct and keep their joints in a neutral position.

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These interventions and their outcomes are recorded by clinicians on the patient’s progress notes and Interdisciplinary Pain Documentation form. This does not only keep all clinicians aware and up-to-date on all new developments, but it also helps to monitor a patient’s pain symptoms, identify patterns in the patient’s pain condition and evaluate the effectiveness of interventions provided. Thus, even when a patient is ready to return home or to the community, the interdisciplinary team can use these insights to make sure the patient is equipped with the knowledge and strategies to prevent pain in their own environment.

Including pain and worsening pain as patient safety indicators in Runnymede’s Quality Improvement Plan is a further testament to the hospital’s commitment to ongoing pain management. In October 2013, the percentage of patients reported to have pain was only 5.1 per cent. This exceeded the target set by the hospital and outperformed the Toronto Central LHIN average of seven per cent. The percent of patients whose pain worsened also improved and is on track to meet defined targets.