A hospital’s buzzes, beeps, bells, and alarms are hardly soothing music for patients dealing with the pain of illness and recovery from procedures. Providers come in and out of rooms, making sleep difficult. Night can turn to day for patients gripped by the effects of powerful drugs.
The jangly hospital environment can also be frustrating for providers looking for non-pharmaceutical ways to comfort their patients, says Amanda “Max” Swedhin, RN, CMSRN, nurse educator for the Medical Surgical Progressive Care Unit (MSPCU) at University of Colorado Hospital.
“There is pain and anxiety for patients when they are in the hospital,” Swedhin says. “As a bedside nurse, I would do what I could to help them, but I often had no resources.”
Swedhin, who co-chairs the Pain Champions Committee at UCH, leads a new effort to change that for both patients and providers. Last May, her unit rolled out “comfort carts” stocked with low-tech items designed to alleviate discomfort and help patients occupy themselves when physical and psychological stress builds. A “Comfort Menu” lists options patients can choose to help control pain and promote relaxation. It’s there for patients in the MSPCU and is also being trialed in the Pulmonary Unit.
No pain, big gain
So far, patients seem to appreciate it. The MSPCU’s scores for providers’ efforts to control pain on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) inpatient surveys improved in at least one key area in the six months following the introduction of the comfort carts, Swedhin said (see graph). That corresponds with a unit survey that indicates more patients were offered “non-medicine interventions” to help decrease their pain.
These techniques include heat, cold, and massage, as well as other tools loaded onto the comfort carts, such as books with crossword puzzles, Sudoku games, and word searches that offer diversion from pain. Earbuds, ear plugs, and sleep masks, help to block out noise and light. CDs with soft music and background sounds offer calm.
Recently added items use aromatherapy to help control pain and anxiety. For example, QueaseEase and Relax 2 the Max, both from Enterprise, Ala.-based Soothing Scents, contain combinations of essential oils such as lavender and peppermint that are formulated to reduce nausea and produce a sense of calm, respectively.
Sweet smell of success
QueaseEase, which was developed by a certified registered nurse anesthetist, encloses a small pad suffused with lavender, spearmint, peppermint, and ginger in a small pod that peels open for patients suffering from nausea to sniff. It was the subject of a quality-improvement project in the Outpatient Pre-Operative and Post-Anesthesia Care units at UCH. The goal: compare provider and patient satisfaction with QueseEase to the standard post-operative nausea and vomiting (PONV) treatment, alcohol prep pads.
According to a report produced by Debra Malone, RN, CAPA, a charge nurse in the Outpatient PACU, QueaseEase rated much higher among both patients and nurses in its ability to control PONV than the alcohol pads. It is now available to providers throughout the hospital (see sidebar).
“Aromatherapy is a nice complementary therapy nurses can give, and it has been well-received by staff,” Malone said.
Swedhin says the MSPCU’s certified nursing assistants (CNAs) have found QueseEase a useful product for managing patients’ discomfort at the bedside. Similarly, Relax 2 the Max sticks, which look something like a magic marker, quickly deliver a precisely metered dose of an essential oil blend developed to reduce anxiety. Patients can use the sticks as often as they want – a measure of control they don’t have with medications, Swedhin said.
“It’s something that people can use to slow down their pain,” Swedhin said. “It gives them something to focus on.”
Changing the channel
The hospital has also taken to the airwaves in an effort to turn patients’ minds toward peaceful thoughts. Of course, every inpatient room has a television, but Swedhin said regular programming – with its alarming news of the world, conflict-riddled reality shows, violence-streaked crime dramas, and the like – can be more hindrance than help for patients worried about their health.
“It can be hard to stay calm with the TV on,” she said. In May, the hospital made “The C.A.R.E. Channel” the default selection on its televisions. The two channels cut the chatter of regular programming and instead dispense quiet music as well as guided imagery to help patients relax and meditate.
“We think the channels help us to improve the environment of care for patients,” Swedhin said.
While the goal of all these efforts is improved patient care, they also could have a significant financial impact. For example, the Centers for Medicare and Medicaid Services (CMS) uses HCAHPS scores as a major component of its value-based purchasing program, which affects hospital Medicare reimbursement.
In addition, alternatives to medications could not only improve patient satisfaction, but also decrease costs safely. Malone concluded that further study could be conducted to determine whether QueaseEase reduces the use of more expensive anti-nausea medications. Swedhin said she plans to analyze the potential effects of the comfort carts and menus on medication use in the MSPCU.
“Our broad goal is to try to decrease the number of medications we give patients,” she said.
Pods beat the odds
Like other nurses in post-anesthesia care units, Debra Malone routinely cares for patients suffering from post-operative nausea and vomiting (PONV). In addition to anti-nausea medications, the go-to treatment has been alcohol pads, an inexpensive option that some patients find repellent.
During recent professional conferences, Malone learned of a product called QueseEase, which counters PONV with the scent of essential oil combinations. Malone was intrigued, and decided for her UEXCEL nurse credentialing project to investigate whether QueaseEase might be an alternative to alcohol pads.
It turned out that getting a supply of QueaseEase pods for research was as simple as calling the manufacturer, Soothing Scents, Malone said. Patients went home after outpatient surgery with a packet containing either QueaseEase pods or alcohol pads and an explanation for using them. In follow-up phone calls after discharge, patients were asked to rate the effectiveness of the aromatherapy they received on a scale of 1-to-5 and to make comments if they wished. Nurses provided the same information about the products.
Both patients and nurses rated QueaseEase significantly more effective than alcohol pads in controlling PONV, but that didn’t make the product a slam dunk for hospital purchase. The pods cost about $6 apiece, Malone said. Alcohol pads had a clear financial edge, even though they dry out in about an hour while a QueaseEase pod lasts about eight.
Malone presented the evidence from her UEXCEL project to one of UCH’s products committees early last summer and answered questions from the members. Despite the cost difference, the committee approved QueaseEase for the PACUs at UCH “for the satisfaction and comfort of patients,” Malone said. The pods are also available for PACUs in UCHealth Northern Colorado and Colorado Springs hospitals if they choose to purchase them.
Because of the price difference, alcohol pads are still the first choice for PONV, Malone said, but she estimated the Outpatient PACU uses about 15 QueaseEase pods a month.
“As a nurse at University Hospital, we’re encouraged and pushed to make innovative change through research and study,” Malone said. “I learned an incredible amount from the UEXCEL project. I also learned that the hospital puts comfort for patients first, rather than the dollar sign.”