Taking a proactive approach to pain management decreases costs and enhances care


Patients come to hospitals looking for care, comfort and pain relief. This is why Toronto East General Hospital (TEGH) has made pain management a priority. In collaboration with several different health-care professionals, the hospital is providing weekly educational sessions and in-services to increase awareness and interventions for patients dealing with pain. “A quick response to pain brings positive results, decreases the length of stay and makes the patient’s experience a lot better,” says Anita Cadeau, palliative care nurse specialist. “As staff, to see that, we feel good and that is the reason why we’re all here.”

Chronic pain affects 20 to 40 per cent of all Canadians and costs the health-care system $6 billion according to The Canadian Pain Society. Experts believe that part of the solution is better education of health-care professionals in their assessment and treatment of pain. Pain can cause serious physical and psychological suffering for a patient, which is why TEGH has taken a stance.

In 2001, the hospital formed the Pain Working Group whose first mission was to develop a policy on pain throughout the facility. Up until that point a consistent policy did not exist in every department. The group has since founded a policy and created the groundwork for pain management at TEGH, whose list of initiatives include electronic pain documenting, CADD pumps and subcutaneous injection sets. The electronic pain documenting enables staff and physicians to access a patient’s pain information from anywhere in the hospital making pain intervention more effective and efficient.

Every initiative requires pain specific training and education for staff and physicians. “I strongly believe that increased knowledge and awareness helps our patients receive better pain management,” says Danuta Jaros, nursing practice leader for pain management. “The goal is to increase functionality and improve the quality of life in this hospital and at home.”

To keep pain management at the top of everyone’s mind, TEGH developed a Pain Champion Program led by Jaros. The year long project was comprised of information sessions and lectures by guest speakers from around the world. The open invitation drew interest from a wide range of disciplines, including social workers, physiotherapists and residents. The culmination of the program in December 2008 hasn’t stopped TEGH’s commitment to creating a pain conscious culture. Every week Jaros organizes in-services to learn about current pain topics, and every month she performs pain rounds, which are open to all staff and physicians.

“The speakers have front-line experience and are informed on new areas of pain management, including anaesthesia, oncology and nurse practice leaders,” says Denise Roberts, RN, surgery. “Nurses need to be aware of the latest trends in pain management in order to be a better advocate for the patient, both during the hospital stay and for care at home post-discharge.”

As a community teaching hospital, TEGH is committed to achieving the highest standards of patient care, which resulted in this proactive approach by the staff and physicians. Their goal was to deliver effective treatment for pain management through communicating with each other and patients. “For example, we now have signs in every patient’s room that reads ‘let us know if you are comfortable.’ We also educate nurses to tell patients what they are doing to them, such as ‘I am assessing you for pain.’ These simple changes in behaviour are helping to get the message out and letting patients know they care.

“We want to raise the bar across the hospital,” reveals Cadeau. The pain initiative at TEGH is unique because it has been led by nurses in partnership with pharmacists and physicians. “This is a team who wants to make things better, and I think we are. We’re seeing how much value we can add by working together. A patient’s life can be a lot more comfortable.”

“TEGH has worked in partnership with RNAO to take advantage of the Fellowship Training Fund which supports nurses to develop in depth knowledge in a particular clinical specialty. For both Anita Cadeau and Danuta Jaros this has provided a wonderful opportunity to specialize in pain management and bring this knowledge and expertise back to the staff at TEGH,” says Marla Fryers, VP Programs and Chief Nursing Officer, TEGH.

Every initiative at the hospital has been geared towards providing a common understanding of pain management and guidelines that the staff and physicians can follow. “Creating the guidelines on pain management facilitates and supports my role in assessment, management and patient advocacy,” says Darina Popivanov, RN, CCU.

The group hopes to work on several more projects in the near future, including communication material for medications and their side effects for patients post-discharge. Most importantly, Cadeau hopes “a lot more staff will feel more confident and comfortable with pain management since they have the resources to understand what to do.”