CHRONIC PAIN MANAGEMENT: TO O LS FO R A C A R E M A N A G ER N IC O LE C A R TER BSN , R N
CHRONIC PAIN MANAGEMENT • “Be st pra c tic e mo de ls fo r c hro nic pa in ma na g e me nt re q uire a multidisc iplina ry a ppro a c h simila r to tha t re c o mme nde d fo r o the r c hro nic c o mple x illne sse s, suc h a s de pre ssio n, de me ntia , e a ting diso rde rs, o r dia b e te s.” • -NI H Re po rt Source: http://annals.org/article.aspx?articleid=2089371
THE TEAM • MD/ NP/ PA • Ca re Ma na g e r/ He a lth Advo c a te • MA/ RN • Psyc ho lo g y/ Psyc hia try • Nutritio n • Physic a l T he ra py • Pha rma c y • T HE PAT I E NT
CLINIC PROCESS • Sc rub c ha rts the nig ht b e fo re (use the te a r o ff pa ds)a nd a dd pa tie nts to c a re ma na g e r sc he dule if ne e de d- MA/ HA • Da y o f: Administe r the initia l o r fo llo w-up pa c ke t-MA • I f the pa tie nt ne e ds a n MMA, Ca re Ma na g e r o r He a lth Advo c a te to disc uss a nd a dministe r b o th this a nd the Opio id F a c t She e t. –HA/ CM • Ca re Ma na g e r to do Se lf-Ca re Pla n o n hig h risk pa tie nts ye a rly (e ve ntua lly a ll c hro nic pa in pa tie nts to re c e ive this.) –CM • MD to g o o ve r pa c ke t a nd c o mple te visit. -MD • Re fe r to Ca re Ma na g e me nt fo r fo llo w up visits thro ug h pho ne c a lls o r o ne -o n-o ne a ppo intme nts a s ne e de d.
WHAT ARE WE LOOKING FOR? Pa tie nt Na me : Ca re Pla n: Ye a rly (Ca re Ma na g e r)-Sta rt with hig h risk pa tie nts MMA: Ye a rly o r PRN (Ca re Ma na g e me nt T e a m) Urine Drug Sc re e n: (At le a st ye a rly, mo re o fte n fo r hig he r risk pa tie nts) PHQ-9: As Ne e de d MS E q uiva le nc y: (Ho pe fully do ne in I CE NT RA) DOPL : E ve ry Visit (c a n b e do ne b y MA thro ug h pro xy)
INITIAL PACKET • Pa in Histo ry https:/ / kr.ihc .c o m/ kr/ Dc mnt? nc id=520978085 • Pa in Co ping surve y • https:/ / kr.ihc .c o m/ kr/ Dc mnt? nc id=520978127 • Curre nt Opio id Misuse Me a sure (COMM) • F o r pa tie nt’ s a lre a dy ta king o pio ids • (Sc o re she e t inc lude d) • https:/ / kr.ihc .c o m/ kr/ Dc mnt? nc id=521022660 • Sc re e ne r a nd Opio id Asse ssme nt fo r Pa tie nts with Pa in- Re vise d (SOAPP-R) • F o r pa tie nts who ha ve ne ve r ta ke n o pio ids b ut a re thinking a b o ut sta rting • (Sc o re she e t inc lude d) • https:/ / kr.ihc .c o m/ kr/ Dc mnt? nc id=521022655 • MHI Pa c ke t
FOLLOW UP PACKET • Brie f Pa in I nve nto ry (sho rt fo rm) https:/ / kr.ihc .c o m/ kr/ Dc mnt? nc id=520978126 • Me dic a tio n F o llo w Up https:/ / kr.ihc .c o m/ kr/ Dc mnt? nc id=520978179 • PHQ9-As Ne e de d
CARE MANAGEMENT PACKET • Ne w MMA F o rm (Ye a rly o r PRN) • Opio id F ACT SHE E T • Ca re Pla n
Date: This management plan is tailored for your situation and needs. While your doctor will treat any conditions that may be causing your pain, this plan is focused on managing the pain itself. For many patients with chronic pain, the pain never completely goes away. But pain management can reduce your pain and help you function better. This plan aims at reducing your pain sensations, helping you move better, helping you sleep better, and improving the quality of your life. You and your doctor will work together to set goals, and your doctor will recommend treatments and self-care strategies to help meet those goals. Patient Selected Goal(s): “As a result of pain management, I want to be able to…” 1. 2. 3. So I can do the things listed above, my goal for pain management is to reduce my pain level to (1-10): SELF MANAGEMENT : We discussed some changes you can make that will help you manage your pain and reach your goals. How IMPORTANT are these changes to you? (1-10): What would help you move from a to a ? How CONFIDENT are you that you can make these changes? (1-10): What would help you move from a to a ? How can your health care team help you with your goals? Self-care goals and monitoring: Check the main goals that you most want to work on now including the first 3 listed Physical activity goal: Meditation goal: Engagement in meaningful activities goal: Anxiety/Depression goal (if needed): Quit tobacco Manage weight Improve sleep habits Attend support group or pain classes Local Resources: Care manager or health educator: Local clinic phone and website: 801/779-6200 Intermountainhealthcare.org/locations/Layton-clinic Other consultants or providers: In pain management, YOU are an important part of the team. Your job will be to keep appointments with your doctor and other healthcare providers, use recommended self-care measures, take medications as prescribed, and follow your doctor’s suggestions.
SELF-CARE PLAN • T his ma na g e me nt pla n is ta ilo re d fo r yo ur situa tio n a nd ne e ds. While yo ur do c to r will tre a t a ny c o nditio ns tha t ma y b e c a using yo ur pa in, this pla n is fo c use d o n ma na g ing the pa in itse lf. F o r ma ny pa tie nts with c hro nic pa in, the pa in ne ve r c o mple te ly g o e s a wa y. But pa in ma na g e me nt c a n re duc e yo ur pa in a nd he lp yo u func tio n b e tte r. T his pla n a ims a t re duc ing yo ur pa in se nsa tio ns, he lping yo u mo ve b e tte r, he lping yo u sle e p b e tte r, a nd impro ving the q ua lity o f yo ur life . Yo u a nd yo ur do c to r will wo rk to g e the r to se t g o a ls, a nd yo ur do c to r will re c o mme nd tre a tme nts a nd se lf-c a re stra te g ie s to he lp me e t tho se g o a ls.
SELF-CARE PLAN CONT. • Patie nt Se le c te d Goal(s): “As a r e sult of pain manage me nt, I want to be able to… ” • 1. • 2. • 3. • So I c an do the things liste d above , my goal for pain e duc e my pain le ve l to (1- 10): manage me nt is to r
SELF-CARE PLAN CONT. • Se lf- c a re g oa ls a nd monitoring : Che c k the main g o als that yo u mo st want to wo rk o n no w inc luding the first 3 liste d Physic a l a c tivity g oa l: Me dita tion g oa l: E ng a g e me nt in me a ning ful a c tivitie s g oa l: Anxie ty/ De pre ssion g oa l (if ne e de d): Quit to b a c c o Ma na g e we ig ht I mpro ve sle e p ha b its Atte nd suppo rt g ro up o r pa in c la sse s
SELF-CARE PLAN CONT. • In pain manage me nt, YOU ar e an impor tant par t of the te am. Yo ur jo b will b e to ke e p a ppo intme nts with yo ur do c to r a nd o the r he a lthc a re pro vide rs, use re c o mme nde d se lf-c a re me a sure s, ta ke me dic a tio ns a s pre sc rib e d, a nd fo llo w yo ur do c to r’ s sug g e stio ns.
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