Collaboration in the Burn Team: Creating a Self-Efficacy-Enhancing Pain Management Protocol for Adult Patients.
Topic of Interest
CNS as Researcher
CNS as Project Manager
Quality Initiatives
Patient Populations
Interprofessional Collaboration
Abstract
Collaboration in the Burn Team: Developing a Self-Efficacy Enhancing Pain Management Protocol for Adult Patients.
Significance and Background
Acute burn pain is difficult to manage, and poorly managed pain can lead to deleterious consequences such as post-traumatic stress disorder, acute stress disorder, prolonged recovery, and long-term dependence on opioids. It was the goal of this verified burn center to investigate the multiple considerations inherent in effectively managing pain, assess weaknesses in our current approach, and develop a comprehensive strategy to improve patient outcomes. A CNS-led multi-disciplinary team comprised of nursing, medical, and mental-health clinicians worked together to develop a multi-modal pain management protocol aimed at improving pain management through self-efficacy-enhancing interventions.
Evaluation Methods
A needs assessment was conducted by performing a comprehensive literature review of burn pain management. An anonymous staff survey was distributed asking burn team staff to rate the efficacy of various aspects of current pain management practices, identify perceived weaknesses and possible improvements in burn pain management.
A quasi-experimental pre-test/post-test design has been employed to evaluate protocol efficacy measuring pain scores, morphine milligram equivalents (MMEs) and coping self-efficacy (CSE) scores with a sample goal of 60 adult burn patients. Staff nurses will be surveyed three months post protocol initiation.
Outcomes
The literature review supported the development of a protocol that synergistically employs patient/family education, pharmacological intervention, and non-pharmacological intervention to improve pain and anxiety management and enhance patient self-efficacy. Per survey results, consistent setting of goals for pain management, and consistent use of nonpharmacological interventions were identified by 71% of survey respondents as needing to be improved upon. Lack of effective patient education and patient coping skills were identified respectively by 78% and 76% of respondents as barriers to successful pain management.
Protocol outcomes are currently being measured.
Implications
This quality improvement process has highlighted the importance of interprofessional collaboration in identifying and addressing practice gaps in a team-oriented practice setting. Standardizing multimodal interventions may enhance self-efficacy, improve overall pain management, and potentially reduce harms associated with poorly controlled burn pain. We hope our practice improvement process can serve as a model to other multi-disciplinary teams in impacting improved patient outcomes and lead to further research and progressive efforts in improving pain management within the burn community.