Showcase Presentation - professionals.wrha.mb.ca · Showcase Presentation November 3rd, 2014 . WRHA...
Transcript of Showcase Presentation - professionals.wrha.mb.ca · Showcase Presentation November 3rd, 2014 . WRHA...
Showcase Presentation
November 3rd, 2014
WRHA Palliative Care Program
• Conducted audits for assessing compliance to Pain Clinical Practice Guideline
• Assessed pain assessment on admission & pain assessed using a standardized assessment tool
Palliative Care Program 2010-12
Pain Assessment done on admission – 83-95% completed – with 3 out of 4 sites scoring 100%
Pain assessed using a standardized tool – 97-98% completed – with 3 out of 4 sites scoring 100%
Palliative Care Program
Next Steps
• Audits will be conducted to assess whether changes in orders for analgesics are accompanied by IPN to document reason for change.
Knowledgeable
Continuous Wound Infusion in Children's Hospital
• Continuous wound infusion (CWI) is a catheter placed by a surgeon to infuse local anesthetic into the surgical wound at the end of the procedure
• Local anesthetic (Ropivacaine) is delivered as a continuous infusion
• CWI is one component of a multi-modal approach to acute care
Continuous Wound Infusion in Children's Hospital
Learned Outcomes:
• Placement of the CWI catheter should not be near a surgical drain
• Ropivacaine does can be just as effective whether the concentration is and the volume – less opportunity for the wound to dehisce
• Multiple successes, still not able to predict who CWI will be effective for
Continuous Wound Infusion in Children's Hospital
Benefits:
• Less systemic opioids required=fewer side effects
• A choice when epidurals are not an option
• Does not interfere with parenteral involvement
• Shorter hospital stay
• Increased Patient and Family satisfaction
Continuous Wound Infusion in Children's Hospital
Next Steps:
• A retrospective chart review to search for a predictive tool for efficacy
Contact:
• Pediatric Acute Pain Service –
Dr. David Lambert & Colleen Weppler
Evidence Based
Concordia Hospital
• Utilized a multi-modal pain model to maximize pain control while minimizing side effects
• Effective for highly acute orthopedic pain
Concordia Hospital
Learned Outcomes:
• Great success with the use of oral ketamine in patients with both opiate tolerance and in the opiate naïve patient – when given early on in the post operative period
Concordia Hospital
Benefits:
• Through ongoing assessment and monitoring, have been able to minimize opiate dosage while maintaining a low pain score
Contact:
• Scott Stephen – Acute Pain Nurse Clinician
Person Centered
Reducing Pain & Fear Minor Procedures in Outpatients
Promoted use of the 3 Ps of pain Relief, to reduce pain from vaccinations in infants
• Physical
• Psychological
• Pharmacological
Reducing Pain & Fear Minor Procedures in Outpatients
Learned Outcomes
• Evidence-based techniques exist to prevent and reduce pain, distress, and fear
• Implementing requires long-term changes in policy, staff training, resources, education of parents, monitoring & supervision
Reducing Pain & Fear Minor Procedures in Outpatients
Learned Outcomes:
• Increased use of positions for comfort, oral sucrose, & distraction with toys for infants receiving vaccinations
• Developed handout for families concerning pain reduction techniques & the importance of reducing procedural pain
Reducing Pain & Fear Minor Procedures in Outpatients
Next Steps:
• Extending the project with additional pain management methods for other age groups, procedures, & outpatient clinics (e.g. blood lab)
Contact:
• Carl von Baeyer, Maureen MacKay, & Nicole Hase-Wilson
Collaboration
Pediatric Pain
Did you know?
• That there is a Pediatric Pain Interdisciplinary Interest Group (PPIIG)
Recent Updates from PPIIG:
• Pain passport
• Pain in children with neurological impairment or developmental delay
• Procedural pain in outpatients
Pediatric Pain Interdisciplinary Interest Group
Possible topics for future meetings:
• Pain care maps
• Topical anesthetics
• Promoting institutional commitment to pediatric pain management
Contact:
• Maureen MacKay & Carl von Baeyer
Educator
Complex Regional Pain Syndrome (CRPS)
• Is a syndrome characterized by a continuing regional pain that appears disproportionate in time or degree to the usual course of any known pathology
• CRPS is the pediatric population is a relatively new entity
Complex Regional Pain Syndrome (CRPS)
Purpose of Project:
• To review the physiotherapy records of all patients referred to physiotherapy at Children’s Hospital with the diagnosis of CRPS or suspected CRPS
Complex Regional Pain Syndrome (CRPS)
Objectives of project:
• Identify differences in presenting signs & symptoms between children/adolescents & adults
• Identify effective/ineffective diagnostic tests & treatment interventions
• Determine if education is required regarding accurate assessment & effective treatments
Complex Regional Pain Syndrome (CRPS)
Outcomes:
• By identifying at risk patients earlier, hope to reduce days lost from school & leisure activities, decrease family anxiety & decrease unnecessary invasive diagnostic procedures
Contact:
• Kathy Mulder, Child Health Program
Resourceful
Shoulder Boot Camp Deer Lodge Centre Rehabilitation
Services
• Group exercise & education program for outpatients with non-operative shoulder pain
• Classes focus on active exercise, self-management, & functional goals
Shoulder Boot Camp DLC Rehabilitation Services
Learned Outcomes:
• Group therapy may be as effective as 1:1
• Social cohesion improves adherence
• Education & exercise promote self-management & goal achievement
Shoulder Boot Camp DLC Rehabilitation Services
Benefits:
• Delivery of evidence-informed exercise & education program
• Achieved same or better clinical outcomes in half the number of visits
• Patient satisfaction higher for group exercise participants compared to site & regional average
Shoulder Boot Camp DLC Rehabilitation Services
Next Steps:
• Continue to improve class & client engagement
• Explore new class ideas
• Spread knowledge
Contact:
• Patricia Huntley
Professional
TootSweet for Pain Relief in Infants
• Oral administration of 1-2 ml of a mild sugar solution = reduced pain from minor medical procedures in infants from birth to 12 months
• Works in phases: immediate phase salience of taste attracts attention, secondary phase of endorphin release
TootSweet for Pain Relief in Infants
Learned Outcomes:
• Initial audits indicated initial communication not as effective as hoped
• Audit itself is a good strategy to promote usage
Contact:
• Lisa Gardewine, Children’s Hospital
Compassionate
Get Better Together!
• A free program for living better with ongoing health conditions – Wellness Institute
Helps Individuals:
• Manage pain
• Deal with fatigue & frustration
• Increase energy levels
Thank you for sharing your work and knowledge!