The Keys to Pain Management for Hospice Patients

Think about the last time you were in pain. Maybe you picked up a sheet of paper and gave yourself a deep paper cut. Perhaps you slipped in the shower and broke your hip. Or possibly you experienced severe pain passing a kidney stone. But what if you had an advanced illness—such as cancer? Can you comprehend the level of pain you would experience, especially if the cancer had metastasized to your bones? Few of us can truly understand this type of pain. That’s why it is extremely important to understand the keys to pain management for hospice patients, no matter what their diagnosis.

Focusing on Pain Management for Hospice Patients

If you had to name the most common symptom reported by hospice patients, what would you say? If you said pain, you are correct. According to studies published in Global Atlas of Palliative Care at the End of Life and the British Medical Journal,  pain is one of the most common and distressing symptoms at the end of life. It also leads many people to seek hospice services.

Based on a proven model for clinical care, it is always important to educate and support patients and caregivers. This is especially true when it comes to pain management for hospice patients.

“In 2016, Chapters Health System launched the multi-phase Pain Management Initiative designed to improve our ability to bring every patient’s pain under control within the first four days after admission and keep the pain under control throughout the course of the patient’s hospice journey,” stated Pam Saucier, RN, BSN, MBA, Chief Compliance and Clinical Officer at Chapters Health.

Hospices use a scale by which patients (or their caregivers, if patients cannot speak for themselves) rate their pain on a scale of 1 (the lowest) to 10 (the highest). If a hospice patient has a pain score of 7 or greater, the situation is considered a hospice emergency. With a focus on pain management for hospice patients, the clinical team constantly monitors patients’ pain scores with a goal of getting their pain level to a 5 or less by the fourth day after admission to any of the Chapters Health affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice.

Pain Management Initiative Explained

The Pain Management Initiative started with an intensive re-education program for staff on pain assessment, pain documentation, and plans and procedures for getting patient pain under control and keeping it that way. Next up, a multidisciplinary team of experts developed a pain protocol whereby patient pain is assessed on every visit by a member of the hospice care team. Any patient who reports a pain score of 7 or greater appears on a twice-daily report. Patients who show up on the pain report receive regular follow-up contact, including phone calls and repeated visits by a nurse—whatever it takes to manage the pain.

Chapters Health physicians and advanced registered nurse practitioners are always available to assess patients in person and adjust medications. Additionally, Chapters Health clinical pharmacists are available 24/7 to review and dispense medication orders.

It takes a balance of the appropriate doses and the proper medications to achieve a level of comfort to help manage hospice patients’ pain.

“It’s an area of expertise,” added Saucier. “This is something we promise our patients we’ll manage effectively. It’s important to our patients. And it’s just as important for caregivers at the bedside and our nurses.”

At Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Pain Comes in All Shapes and Sizes

For the most part, thinking about end-of-life pain conjures up an image of a patient with cancer, especially pancreatic or prostate cancer with metastatic bone disease. However, pain is also a common symptom for non-cancerous and life-limiting illnesses, such as chronic obstructive pulmonary disease (COPD) and end-stage congestive heart failure (CHF). Additionally, pain in chronic illnesses may be related to diseases or side effects of treatment, which are similar to patients with cancer.

There have been studies that demonstrated the pain people experience as cancer patients is different than others with non-cancer diagnoses. Publishing their results in Drugs Aging, Prommer and Ficek from the Mayo Clinic confirmed this theory. A Norwegian research group went a step further in its analysis. The group found patients with non-cancer illnesses had a higher prevalence of mild to moderate pain, while advanced cancer patients were more likely to experience a greater intensity of pain, which was described as severe to excruciating.

Oftentimes, family members/caregivers are called upon to play an active role in the pain management of hospice patients. Not only do they give the medication, but they are also tasked with describing the pain to hospice staff. This observation prompted Campbell and her associates at the University of Virginia to delve into even more detail about the pain management of hospice patients and whether there was a difference in outcome for those with cancer versus non-cancer.

The group specifically looked at pain scores at two points in time, prescribed medications and the percentage of patients in each group who were able to report on their pain intensity. In June 2017, they published the results of their study in Nursing and Health Science. The group concluded that it is important to actively involve patients’ caregivers in medication administration along with educating them properly on the safe use of all medication, regardless of drug type. It is also helpful to cue caregivers to understand non-verbal pain indicators and to help better manage intensity and keep hospice patients more comfortable.