A Quality Initiative Incorporating Tablet Technology to Facilitate Nonpharmacologic Pain Intervention Use in the Hospital.

BACKGROUND: The opioid crisis has changed the culture and expectations of pain management, elevating the importance of nonpharmacologic pain interventions (NPIs) into multimodal pain management programs. Little is known about use of NPIs in hospitalized patients. AIMS: This quality improvement project aimed to increase awareness and use of NPIs by engaging patients and nurses on one medical unit using tablet technology. METHODS: Pre- and post intervention data were collected using surveys of nurse and nursing assistant perceptions of NPIs and by assessing pain management experiences of acute care patients using the American Pain Society-Pain Outcomes Questionnaire-Revised. Interventions included staff education, integration of an NPI menu and tools onto bedside tablets, and a Comfort Card communication tool. SETTINGS: This Quality Improvement project was conducted on an 18-bed adult medical unit at a Midwestern academic medical center. PARTICIPANTS/SUBJECTS: Subjects included RN and Certified Nursing Assistants from one medical unit. Patient perspectives were obtained from a baseline cohort of 30 hospitalized medical patients and compared to an intervention group of 15 medical patients. Patient inclusion criteria included adults ages 18 and older, hospitalized ≤72 hours, who verbalized a willingness to participate. DESIGN: The 8-week project included nurse and nursing assistant pre-/post-intervention perception surveys and an educational module about NPIs. Pain management experiences and NPI use were assessed post-tablet intervention using the American Pain Society-Pain Outcomes Questionnaire-Revised (APS-POQ-R). Additionally, staff education, integration of an NPI menu and tools onto bedside tablets, and a Comfort Card communication tool were planned interventions. RESULTS: Nursing staff believe NPIs are beneficial, safe, and evidence-based; however, limited resources, time constraints, and lack of provider support are perceived as barriers. Staff and volunteers provided 80 comfort items to 38 patients during the project. Half of baseline patients (n = 30) and intervention (n = 15) groups reported not receiving information about pain treatment options. Many patients in both groups denied using "non medicine methods," but further assessment revealed that 90% of the baseline group and 87% of the intervention group had used an NPI. CONCLUSIONS: Results suggest that patients and nurses may benefit from education about using NPIs in acute care. Nurses have a critical role influencing positive pain-related outcomes, and tablet technology can enhance patient use of NPIs during hospitalization.

Methodology and baseline characteristics of a randomized controlled trial testing a health care professional and peer-support program for patients with chronic obstructive pulmonary disease: The BREATHE2 study.

BACKGROUND: Self-management support (SMS) for patients with COPD can improve health-related quality of life (HRQOL). However, it remains unclear what SMS strategies are most effective. Using peer support to advance self-management is promising, as peer supporters possess credibility and can serve as role models. METHODS: We conducted a single-blinded RCT comparing the effectiveness of two strategies to support patients with COPD. The strategies were 'Health Care Professional (HCP)' and 'HCP Plus Peer' support. Peer support was provided by patients with COPD who have stopped smoking, completed an acute pulmonary rehabilitation program, and met the requirements for becoming a peer supporter. We enrolled patients receiving treatment at inpatient and outpatient settings. Patients were encouraged to invite one family-caregiver to enroll with them. The primary outcome measure was the change in HRQOL at 6 months post enrollment. Secondary outcomes included COPD-related and all-cause hospitalizations and ED visits. Caregiver outcomes included preparedness for caregiving, caregiver stress, and coping. RESULTS: A total of 292 patients as well as 50 family-caregivers were enrolled. The average patient age was 67.3 yrs. (SD 9.4), 61% were female and 26% were African-Americans. The majority of caregivers were females (68%) and were a spouse/partner (58%). DISCUSSION: This study tested a dual strategy for providing support to patients with COPD that incorporates peer and health care professional support. The study had minimal exclusion criteria. If shown effective, the study offers a program of peer support that can be readily implemented in health care settings.

Collaboration for prevention of chronic disease in Kentucky: the Health Education Through Extension Leaders (HEEL) program.

Health Education Through Extension Leaders (HEEL) is one of the solutions the University of Kentucky College of Agriculture has created to address the problem of chronic disease in Kentucky. Building on the land grant model for education, outreach, and prevention, HEEL collaborates and partners with the academic health centers, area health education centers, the Center for Rural Health, the Kentucky Cancer Program, the Markey Cancer Center, the University of Kansas Wellness Program, and the Kentucky Cabinet for Health and Family Services to implement research-based preventive programs to the county extension agents across Kentucky. Extension agents are an instrumental bridge between the communities across Kentucky and the educational resources provided by the HEEL program.

Determining standards of care for substance abuse and alcohol use in long-haul truck drivers.

The trucking industry employs approximately 9 million workers, with approximately 3 million being long-haul truck drivers. Truck drivers are exposed to a variety of stressful situations, such as working long hours, no sleep, inadequate rest and relaxation, being away from home and support systems, and driving in hazardous conditions. These risk factors place the long-haul truck driver at an increased risk for possible use or abuse of alcohol and drugs. Identification of those at risk and those who are abusing alcohol and drugs is vitally important for the health of these truckers.