See My Suffering: Utilizing the DisDat ™ Tool to Identify Suffering in Developmental Delay
Topic of Interest
CNS as Project Manager
Role of CNS in Diversity and Inclusion
Patient Populations
Interprofessional Collaboration
Abstract
See My Suffering: Utilizing the DisDat ™ Tool to Identify Suffering in Developmental Delay
Jeannette (Jeannie) Meyer, MSN, RN, CCRN-K, CCNS, PCCN-K, ACHPN
Mary Beth Chambers, DNP, RN-BC, ACNS, ACHPN
Grace Sund, RN, MSN, CPNP, CPHON
Background: Evidence- based pain scales such as FLACC™, Pain AD ™ and CPOT ™ are often utilized to assess pain and guide treatment for adult and pediatric patients who are unable to communicate verbally. However, such scales may not be the best assessment tools for patients with Developmental Delay (DD), whose manifestations of pain and discomfort may differ from most nonverbal individuals. DisDat ™ captures individual manifestations of pain for each patient and allows for those manifestations to be readily available by healthcare providers. DisDat ™ is completed by the caregiver most familiar with the adult or child with DD. The need for the DisDat ™ was identified in both the adult and pediatric populations at an Academic Medical Center.
Objectives:
- To support the moral agency of interdisciplinary team members in the delivery of patient centered pain management for the DD population admitted to the inpatient setting.
- Anticipate the need for specialized assess method for individuals with Developmental Delay
- To design and implement a reliable process supporting the completion of DisDat ™ for patients diagnosed with DD to improve communication and staff recognition of patient specific pain behaviors.
Methods: A palliative care led multidisciplinary team including stakeholders from pediatrics, adult and psychiatry outpatient and inpatient settings convened over the course of a one-year period to pilot and explore methods for implementation of the DisDat ™. A pilot of the tool was tested on one pediatric unit in collaboration with the outpatient long term care facility for these patients over a period of 9 months. Additional DisDat ™ tools were completed for adult patients with DD receiving care from by a Palliative Care physician team member. Copies of the DisDat ™ were made available to caregivers; a copy of the all-inclusive first page of the DisDat ™ was posted at the patient’s bedside for easy referral.
Results: 6 patients had baseline data completed using DisDat ™. The DisDat ™ was positively received by hospital staff and the long-term care facility that integrated the tool into their Admission process.
Conclusions: Based on the low volume results and understanding that these patients can be admitted to multiple services and locations throughout the healthcare system, the team designed a reliable system wide implementation strategy for high-risk-low-volume patients using lean methods. The process includes DD diagnosis data capture in the EMR on admission triggering an automatic page to Clinical Nurse Specialists (CNSs). CNSs will facilitate completion of the form and offer just-in-time education to staff caring for DD patients. ICD 10 codes have been identified and the build for the automatic trigger is in process pending system wide roll out. Completed forms will be located in the advance directive section of the EMR.
Implications for Practice: Individuals with DD until this time have lacked a discomfort assessment tool that would provide access to their individual manifestations. DisDat ™ offers an opportunity to more appropriately meet the pain and discomfort management needs of this high-risk-low-volume population.