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MOPAT A new tool for assessing pain inhospice patients who can’t self-

report

Presenters:Deborah Bortle, MS, BSN, CHPN

Joan K. Harrold, MD, MPH, FACP, FAAHPM

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Pain Assessment in Hos i!ePatients

Patients able to sel"#re ortPatients not able to sel"#re ort

Ho$ do $e it%&hat are the !hallen'es%&hat do $e need%

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MOPAT: M(ltidimensionalOb)e!ti*e Pain Assessment

Tool+ni*ersit o" Mar land S!hool o" N(rsin'

Preliminar $or- M!/(ire 0 1ei"sn der, 23345s(''ested that at least 2 dimensions o" a!(te

ain6beha*ioral and h siolo'i!6!o(ld beassessed in non#!omm(ni!ati*e alliati*e !are

atients./oal: to *alidate the MOPAT and demonstrateits "easibilit in a s e!tr(m o" alliati*e !aresettin's $hen (sed b both n(rses and in"ormal!are'i*ers to assess a!(te ain in non#!omm(ni!ati*e atients.

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MOPATHos i!e o" 7an!aster Co(ntADC 483#833

92 bed P+, mainl / PSe!ond P+ o ened, 9; beds, mainl / P1esear!h MS

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MOPAT in Hos i!e1emo*e blood ress(re meas(rementsNot ro(tinel er"ormed, es e!iall at =O7

Co(ld limit "(t(re !lini!al (tilitSta> other than n(rsesOther !are'i*ers

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St(d Desi'n=li'ible P+ atients s(s e!ted o" ha*in' ainSim(ltaneo(s MOPAT assessments b St(d1N and Sta> n(rse 1N or 7PN5

9 rimar St(d 1N $ith 9 ba!-#(1eassessment "ollo$in' inter*ention

Timin' based on inter*ention (sedSta> MOPAT res(lts do!(mented in =M1

St(d MOPAT res(lts not in!l(ded in atientre!ordSerial *al(es $ere (sed !lini!all e*en i" notre!orded "or the st(d

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n!l(sions

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MOPAT

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Trainin' Trained sta> o*er months 1Ns and 22 7PNs a'reed to arti!i ate in st(d

9 1N and 9 7PN de!lined, b(t still (tili ed MOPATSame instr(!tor "or e*er oneO(t o" the P+ "or trainin'Asso!iated !olor: P+1P7= ma'nets

n!l(ded sna!-s Than- o( 'i"t: MOPAT !li boardFeedba!- *ia Eiers $hen 'eneral iss(esidenti ed

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Clini!al +tilitAssessmentCom leted monthl b n(rses $ho

*ol(nteered to arti!i ate in this arm o" st(dNo additional in!enti*es

Did n(rses li-e the tool%&o(ld the (se the tool%

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Patient =nrollmentPro)e!t be'an Mar!h G, 233N(rses had #8 months to (se be"oreenrollment atient

83 atients enrolled b De!ember 99, 2337ast atient enrolled No*ember 2 , 239329 month enrollment eriod "or 933 atients

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Challen'es to =nrollmentP+ trans"ers 8 m# am and on Sat(rda sO enin' o" ne$ P+ G miles a$a

1easons not enrolled:83 dia'noses in!l(ded dementia22 died rior to st(d assessment23 died be"ore re#assessment2 st(d n(rse not a*ailable2 1AST @ 8

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1es(lts: N(rses (sin'MOPAT

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1es(lts: 1et(rn 1ateC+I s 5

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1es(lts o" MOPAT inHos i!e1eliabilit

A'reement bet$een St(d n(rse and Sta>N(rse raters $as si'ni !ant at @.339, $ithmoderate#s(bstantial a'reement on mostindi!ators.

alidit

alidit $as e*iden!ed b statisti!allsi'ni !ant @.3395 red(!tions in beha*ioral,h siolo'i!, and total MOPAT s!ores "ollo$in'ain inter*entions.

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Clini!al +tilitI(estionnaire

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1es(lts: +tilit/(ided ain assessmentAssisted in !omm(ni!ation

Hel ed determine i" ainresentHel ed determineinter*ention needed

; .;9.9

;9.;;3.

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1es(lts: =ase o" +se1easonable time to !om lete ; .=as to (se G9.8

Feasible "or re'(lar (se 8G.=as to (nderstand G9.

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Ad)(stments to MOPAT=liminate dia horesis on MOPAT toolAdded no *al(e

Shortened time to !om lete

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Home Hos i!e 1oll#o(t1oll o(t to admission team rst Tried to 'et their "eedba!- be"ore HH roll o(t

=asier to (se than the e? e!ted7i-ed an ob)e!ti*e toolDidn t li-e ha*in' another "orm to !om lete

1e!o'ni ed need "or standardi ed tool "or

atients $ith dementia $ho !annot sel"#re ortDementia in P+ a!!o(nted "or 83 o" thosee?!l(ded "rom MOPAT st(dPA NAD added to =M1 rior to HH roll#o(t

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ss(es in Home Hos i!eN(rses (sin' assessment tools inter!han'eabl=*en "or same atient

More than e? e!ted "rom E(!t(ations in !lini!al stat(s

+sin' sel"#re ort $hile a$a-e and MOPAT $hile aslee+sin' MOPAT and PA NAD "or same atient

N(rses onl (sin' a tool a"ter the determineatient has ain

Need to (se to hel determineif

a atient has ainAllo$s ne?t !lini!ian to !om are ain le*els (sin'same *ariablesComm(ni!ation, not !lini!al a!!(ra!

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ss(es in Home Hos i!eDe nition o" dementia4. $ith dementia had a MOPAT !om leted

=m hasi e sel"#re ort rst&hat !onstit(tes a dia'nosis o" dementia%Problem or d? list% Famil re ort% Clini!al notes%

Timin' o" "o!(s on NIF 323

Com"ort in 4 ho(rsSel"#re ort onlDiminished "o!(s on assessment o" atients$ho !annot sel"#re ort

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7essons 7earned1oll#o(t $ith "an"areNeed e?!itement to ma-e an im ression

Don t roll#o(t $ith too man other ne$ thin's+se the *ideo s!enarios in all trainin'As- "or "eedba!-

Can (se the C+I, b(t not e*er month

Deli*er ra id "eedba!- to teams on MOPAT (seDe*elo or'ani ational oli! re'ardin'dementia dia'nosis

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F(t(re Dire!tions+se C+I s to 'et n(rsin' "eedba!- in HomeHos i!e

Be'innin' Jan(ar 239=? lore (se b other !are'i*ers

N(rsin' home !lini!iansCare'i*ers at home

C+I: MOPAT !o(ld be (sed b in"ormal !are'i*ers9. disa'ree. (nde!ided

8 .2 a'ree

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A re!iation to O(rCollea'(esDeborah M!/(ire, PhD, 1N, FAAN

Prin!i al in*esti'ator

Karen Kaiser, PhD, 1N#BC, AOCNKaren Soe-en, PhD JoAnne 1ei"sn der, PhD, ACHPN