# Presentation: 205920

## Pain Resource Professional:  A “How-To” Discussion

- Mary Karfonta, MSN, NP
- Jill Klayman, Ph.D.

*November 7, 2006*

**Notes:**
Good Morning!

Jill & I are hoping that today’s teleconference will be an exchange of ideas regarding the progress, practice & pitfalls of the Pain Resource Professional Programs across the VA

Next slide

## OVERVIEW

- How It All Began
- Where We Are Now
- Problems and Solutions
- New Directions
- Discussion

**Notes:**
We’re going to present a brief overview of our program in Milwaukee & VISN 12 and then open the call up for discussion
Next slide, please

## The Beginning - 1997

- PRN Program – Sponsored by UW Madison School of Nursing and the University Hospital
- Modeled after the City of Hope Program in California
- Teaching strategies include lectures, case studies, group discussions, and practical application of pain management principles

**Notes:**
The first regional Pain Resource Training Program was held in December 1997.   It was sponsored by UW-Madison Dept of Nursing & Hospital and was modeled after the the City of Hope program in California.    The program was found to be a cost-effective, decentralized approach to Pain management.
The teaching strategies include lectures, case studies, group discussions & practical applications of pain management principles.  It featured nationally recognized pain experts including June Dahl & Betty Ferrell
Several of our VISN 12 hospitals sent nurses to this program
Next slide

## Paice JA, Barnard C, Creamer J, Omerod K.
    Creating organizational change through the Pain Resource Nurse program.Jt Comm J Qual Patient Saf. 2006 Jan;32(1):24-31. PMID: 16514936 
Holley S, McMillan SC, Hagan SJ, Palacios P, Rosenberg D. Pain resource nurses: believing the patients, and believing in themselves.Oncol Nurs Forum. 2005 Jul 1;32(4):843-8. PMID: 15990913 

-    _[ ](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16514936&itool=iconabstr&query_hl=11&itool=pubmed_docsum)__Creating organizational change through the Pain Resource Nurse program.__Jt Comm J Qual Patient Saf. 2006 Jan;32(1):24-31. __PMID: 16514936 _
- Holley S, McMillan SC, Hagan SJ, Palacios P, Rosenberg D. Pain resource nurses: believing the patients, and believing in themselves.Oncol Nurs Forum. 2005 Jul 1;32(4):843-8. PMID: 15990913

**Notes:**
I’ve included here a few research studies that show the effectiveness of PRN or PRP programs

***RESULTS: Significant improvements were seen in knowledge and attitude of the participants, along with reduced turnover, improved patient satisfaction with pain control, a reduction in the prevalence of pain, and a greater percentage of patients who remembered speaking with a doctor or nurse about their pain (93% versus 89%). In SUMMARY: The found the PRN program is an effective strategy in creating organizational change to improve the state of pain control. 
In the next study 
They concluded that The pain-training course the PRNs received enabled them to practice as confident, credible, and empowered professionals. The awareness that they acquired during the course and the year of practice allowed the PRNs to be patient advocates, role models, and educators. The findings of this study indicate a high level of nurse satisfaction with the PRN role. Nurses with an interest and specialized knowledge in pain assessment and management at the unit level greatly improved patient outcomes. 
Next slide.......

## How It All Began

**The VHA National Pain Management Strategy was initiated November 12, 1998, and established Pain Management as a National Priority.**

**Notes:**
One year later in 1998 the VHA National Pain Management Strategy was initiated , next slide ...........

##  Clinician Competence and Expertise in Pain Management 

1. All clinical staff (e.g., physicians, nurses and therapists) must have appropriate orientation and employee education related to pain assessment and pain management. 
2. There must be an annual pain management education for clinical staff that must include, as appropriate: 
a. Principles of pain assessment and management; and 
b. Treatment modalities including pharmacologic (especially opiates and including education regarding physical dependency, pseudoaddiction, tolerance, and potential for addiction, effects, appropriate titration, side effects, and benefits), and non-pharmacological (including psychological, physical, complementary, and spiritual). 

- 1. All clinical staff (e.g., physicians, nurses and therapists) must have appropriate orientation and employee education related to pain assessment and pain management.
- 2. There must be an annual pain management education for clinical staff that must include, as appropriate:
- a. Principles of pain assessment and management; and
- b. Treatment modalities including pharmacologic (especially opiates and including education regarding physical dependency, pseudoaddiction, tolerance, and potential for addiction, effects, appropriate titration, side effects, and benefits), and non-pharmacological (including psychological, physical, complementary, and spiritual).

**Notes:**
the Strategy it addresses  the need for clinical competence
Next slide.......

## How It All Began

- VISN 12 Held First Pain Resource Professional Programs in 2000 & 2001

**Notes:**
By that time we had already established a VISN Pain Committee that brought together members from each facility’s Pain Committee.    It was established as a multidisciplinary group & that is how we decided to change from Pain Resource Nurse to Pain Resource Professional.
We held our first VISN programs in May 2000, because of the size of the VISN we held 
Southern Tier & Northern Tier conference on consecutive weeks.
Then in September 2001 we held 
One centrally located one-day conference September 2001;  >200 participants
For all of these conferences we received assistance from EES out of Minneapolis.  
The 2001 conference featured initial training  and advanced training tracks so that those who attended the conference in 2000 could further their education and establish networking ties.   

## Goal of VISN 12 PRP Program	

- To prepare sufficient numbers of staff so that a PRP is  available as a resource for pain management on every inpatient unit & clinic setting

**Notes:**
Our goal for these  training sessions was to prepare a sufficient number of staff so that a PRP would be  available as a resource for pain management on every inpatient unit & clinic setting across the VISN

## Pain Resource Nurse Training Course 

- September 5, 6, 7,  20078:00 a.m. - 4:00 p.m.
- at the City of Hope National Medical Center

| 
           Featured Speaker:         Coming soon! 
           Presented by:           City of Hope Comprehensive Cancer Center           Department of Nursing Research & Education                      Cosponsored by:           The Southern California Cancer Pain Initiative           The American Cancer Society
             |                                                                                                                                                                                                                                                                                                                                                                   |
| --- | --- |

**Notes:**
On the next slide I just included  a copy of the upcoming program from City of Hope , they still hold an annual PRN training conference

## Slide 10

**Notes:**
This next  slide just shows the reporting structure for our PRP Program .  Jill Klayman & Kathy Lemere co-chair this program.  Jill is also chair of education for the VISN 12 Pain Committee.   And I am turning you over to her now, thank you

## Where We Are Now

- Self-Paced Training
- Training Marathons
- Case Discussion
- Mentoring

**Notes:**
Although our VISN 12 Pain Education Conferences were very successful, budgetary and time constraints made it impossible to continue training PRPs in an annual conference, so if you change to the slide entitled “where we are now” you can see that we developed a self-paced training module to allow PRPs to complete training in a manner that is more affordable and less disruptive to their schedules.  PRPs are required to obtain education in pathophysiology & assessment, pharmacology, physical & cognitive-behavioral approaches, and special populations by selecting either to watch video recordings or read specific chapters from a book on pain management nursing.  They then need to review case examples and discuss their role with a seasoned PRP mentor.  At times, we have offered a training marathon, where new PRPs watched the videos and engaged in discussion all in 1 afternoon.  

## Where We Are Now

- Role of the PRP
-                             Position Requirements
- Complete at least 1 hour of continuing pain education per quarter.
- Demonstrate your awareness of information covered in quarterly PRP business meetings by attending the meetings and/or by reading the minutes distributed via email.
- Provide pain education to all staff in your work area (all 3 shifts) twice per year.  This may be completed in person or by providing self-study materials.

**Notes:**
The next slide covers the role of the PRP.  Basically, PRPs agree to further their own education in pain assessment and pain management, and then to share pertinent information with colleagues in their clinics or on their units.  PRPs sign a commitment statement that lists the position requirements you see here. By agreeing to be PRPs, they are obligated to complete at least 1 hr of continuing pain education per quarter.  We offer opportunities to complete education in-house, but they can also engage in reading or attend community-based pain education if they choose.  PRPs are also obligated to provide pain education to all staff in their work areas, covering all 3 shifts, at least 2x/year.  In fact, all VISN 12 facilities report their success at providing on-unit pain education to VISN 12 Quality Council on an annual basis.  We also request that PRPs make themselves available as resource people as needed.

Although they did not formally commit to this role, we have requested PRP involvement when designing pain education and templates for pain screenings and assessments.  They have also taken a leadership role in making sure that nursing staff consistently document effectiveness of prn pain meds on their units.

## Problems and Solutions

- Participation and Involvement
- 	•  Include Program Managers
- 	•  Annual Self-Assessment
- 	•  Recognition and Rewards
- Ongoing Education
- 	 • Video Presentations
- 	 • On-line Education Opportunities
- 	 • E-mail

**Notes:**
The next slide features problems and solutions.  
I suspect we are not alone in struggling with attendance at meetings.  It’s very hard for floor nurses in particular to attend meetings consistently.  We have made several changes to bolster attendance. 
One thing we do is involve Program Managers by having them sign the PRP’s Commitment statement and adding them to the email list.  This way they are aware from the beginning of a need to give the PRP sufficient time to meet PRP obligations.  Also,  we have PRPs provide an annual Self-Assessment detailing how they did or did not meet their obligations as a PRP.  This way, if PRPs failed to obtain continuing pain education due to a time constraint, this would be documented.  We request that the PRP and program managers work together to develop an action plan for success.  In the self-assessment, PRPs document the continuing education they obtained and provided, and they are also given the opportunity to list examples of how they were a resource on their unit.  We commitment to the PRP program, we 

 Provide multiple opportunities for PRPs to meet their obligations via minutes, videoed presentations, audio dial-in.  Basically we realize that the more we mandate attendance, the less likely it is that PRPs will successfully meet their obligations. 
Our meeting times and inservices always occur at the same time each quarter, so PRPs can request that time way in advance.  We try to entice PRPs to attend by bringing chocolate or other goodies...I’m not sure that this works, but it sure doesn’t hurt.  

Another challenge is providing ongoing education for PRPs...again, we have to minimize the time commitment and also keep budgetary considerations in mind
Inservices following every PRP business meeting
 VISN-wide education via Pic-Tel
 Email pain ed articles/links
 recent presentation sent via computer (Healing Touch)

## Pain Awareness Month

- Day-long Conferences
- 	 • Annual VISN-wide “Pain Management for the         Primary Care  Provider” Conference
-  	 • CAM
- Noon-time Presentations
- Patient/Staff Education Fairs
- On-unit/In-clinic Pain Inservices
- Recognition

**Notes:**
One thing we’re really proud of is our annual Pain Awareness Month.  It has been evolving through the years.  It gives us an opportunity to showcase our program and accomplishments as well as provide quality continuing education.  

## New Directions

- Competencies
- OEF/OIF
- Integrative Health

**Notes:**
We have some areas where we’ve identified problems, but haven’t yet worked out solutions, so would love to hear what other VAs are doing in these areas.  
Verifying the competency of PRPs in this role...self-assessment says they’ve provided education and served as a resource, but doesn’t say if they were good at it...also, how do we distinguish  and assess what PRPs need to know about pain assessment/management from what staff in general need to know.  
 Do the PRPs have something specific to offer to returning veterans or to staff addressing problems of returning veterans?
 Given the limitations of medical management of pain, should our VA be exploring the role of CAM.  Do the PRPs have something specific to offer in this arena?

## Discussion

- Best Practice Models
- Suggestions
- Wish Lists
-  ????

**Notes:**
I’d like to open it up now to the group for discussion.  We hope people would be willing to share examples of best practice, to offer suggestions, and to talk abou  

## Contact Information

- _[Mary.Karfonta@va.gov](mailto:Mary.Karfonta@va.gov)__  - _
- toll free 888-469-6614, ext. 42106
- _[Jill.Klayman@va.gov](mailto:Jill.Klayman@va.gov)__ – _
- toll free 888-469-6614, ext. 47390

## Thank you

*Thank you*