Pain

C4I Palliative Care and Pain Subgroup

The Palliative Care and Pain Subgroup is one of seven subgroups that have been established to improve patient safety and quality care. The group consists of doctors, nurses, administrators, and medical support staff, who are dedicated to creating excellence in patient care.

Introduction

Acute pain is common in hospitalized patients. Statistics show that under-treatment of pain occurs in 60 percent of the more than 25,000,000 patients undergoing surgery each year. Other studies show that 70 percent of cancer patients have pain – most considered easily controllable. Nevertheless more than 60 percent receive inadequate treatment. There are 50,000,000 patients with chronic, non-cancer pain in the United States. In addition to the suffering, the economic burdens are staggering: 550 million work days lost at a cost of over $100 billion. Under-treatment of many different types of pain is a major problem and deserves our attention.

Administering more and more pain medication is not the answer. Strong pain medications may have dangerous side effects or adverse events, including an inability to breathe and over sedation or sleepiness and even death. There are also other significant potential adverse events, such as nausea, intense itching, and severe constipation.

Patients bring other variables to treatment – some are so stoical that they do not request pain medication. This unrelieved pain impairs healing, slows recovery of function, lengthens the time of illness, and delays the return to normal life and work. Others have such a low pain threshold that overdosing can easily occur. There are those with pain-seeking behavior and addiction problems – yet the risk of addiction in patients with acute pain is very, very low.

The principles of treatment and the types of both caregiver and patient perceptions can easily be learned. We hope that better control of pain while avoiding side effects result in better and safer patient outcomes.

Our Mission

The Palliative Care and Pain Subgroup supports the patient care, teaching and research goals of the Collaborative Center for Clinical Care Improvement through:

• improving quality and safety of patient care as it relates to best practices of pain management and documentation.
• assess and improving, wherever possible, patient and caregiver satisfaction in the management of pain.
• supporting the UConn Health Center Clinical Enterprise vision and C4I strategic goals as they relate to pain management.
• creating institution-wide educational resources.
• contributing to the education of all health care professionals in the UConn Health Center.
• utilizing non-pharmaceutical strategies for pain intervention.
• creating research studies in the clinical environment in order to document effectiveness of process and outcomes for publication.

Palliative Care and Pain Team

Nancy Baccaro, A.P.R.N., and John D. Nash, M.D., of the Neag Comprehensive Cancer Center head a Palliative Care and Pain inpatient service. The team includes social workers, nurse managers, and case managers from each floor so the team won’t be intrusive but rather an extension of the floor team. The team is available to see patients with problems by paging Nancy Baccaro at 860-825-0145. She also helps with pre-admission orders for patients on chronic opioids and makes calculations of IV equivalents and recommendations for post-operative management.

C4I Palliative Care and Pain Subgroup Goals

• Improve quality and safety of patient care as it relates to best practices of pain management and documentation.
• To assess and improve satisfaction are truly the desired goals of treating patients’ pain. Yet, there is a spectrum of reactions to pain and these are influenced by cultural factors. We know that after the same surgical procedure some patients ‘suffer in silence,’ others cry out in anguish for more medication, and neither patient nor caregivers can define exactly the ‘right’ amount. The subgroup has undertaken exploration of satisfaction data from prior patients, analysis of current practice and methods to deliver better pain management. In doing so, we know that improved management can foster, in addition to better care and patient satisfaction, the decrease of side effects and adverse outcomes, and decrease the length of stay, discharges and costs. Finally, satisfaction can be improved for caregivers themselves as well as improving documentation and communication.
• Establish an institution-wide educational resources, such as the Pocket Reference for Pain Management for the UConn Health Center. This guide includes: Principles of Pain Management, Adult and Pediatric Opioid Equianalgesic Conversion Data, Transdermal Fentanyl and Oral/IV Morphine Equivalency, Adult PCA Standard Dosing, Adult Non-opioid Analgesic Adjutants, Treatment of Adult Common Adverse Drug Effects, and PRN Breakthrough Dosing. Assessing knowledge of all care providers of this basic information is planned as well.

Co-chairs, C4I Pain and Palliative Care Subgroup

Joseph M. Civetta, M.D.
Professor
Department of Surgery

Kevin Chamberlin, PharmD
Assistant Clinical Professor of Pharmacy Practice
UConn School of Pharmacy
Assistant Clinical Professor
UConn Health Center Department of Medicine and Center on Aging

John D. Nash, M.D.
Associate Professor
Department of Obstetrics and Gynecology
Neag Comprehensive Cancer Center
Director of Clinical Affairs and Administration