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!