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Hospitals Try Pain Mitigation Techniques

Alternative approaches can improve patient satisfaction, but costs vary

Efforts to lessen or avoid negative patient experiences, including pain, are getting greater attention as the influence of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on reimbursements grows, according to an article posted on the HealthLeaders Media website.

“We seek to minimize pain as much as possible,” said Lisa Dabby, MD, an attending physician in the UCLA Medical Center’s emergency department in Santa Monica, California. Dabby uses the following pain mitigation methods:

  • Applying “liquid stitches” –– Dermabond dermal adhesive (Ethicon US/Johnson & Johnson) –– in place of traditional stitches
  • Administering vaccines, pain killers, and other medications through nasal sprays or transdermal patches rather than intravenously
  • Applying a topical anesthetic before starting an intravenous (IV) line or administering an injection
  • Employing ultrasound-guided IVs and vein finders to reduce the number of failed venipuncture attempts

Deb Bruene, MA, RN-BC, a nurse at the University of Iowa Children’s Hospital, has had success with pain-blocking devices, such as Buzzy Bee (MMJ Labs) and Sofstic (Numblebee, LLC), which numb an area of skin by using vibrations and cold. The proper use of painkillers can improve the patient’s experience as well, Bruene said.

But pain reduction methods have their limitations.

Topical pain-relieving creams and sprays mitigate only surface pain, noted Peggy Riley, RN, MN, MPH, a pediatric pain clinical nurse specialist at the University of Wisconsin Hospitals and Clinics in Madison. Topical medications “provide relief as the needle pokes into the skin, but not as it goes into muscle,” she explained.

And then there’s the matter of effectiveness. Some of the methods touted as less painful work only on minor or moderately severe injuries. Liquid stitches, for example, should not be used on injuries larger than two inches in diameter or in high-tension areas. “It should be an area that needs one stitch or two,” Dabby said. Liquid stitches should not be used on a large gash or on a surgical wound.

In addition, the cost of pain-mitigating hospital supplies can vary widely depending on the institution’s negotiating power, the product’s novelty, and its availability.

Adam Higman, vice president of Soyring Consulting, a health care efficiency consultancy, said he has found that Dermabond is more expensive than traditional stitches. The price is “$20 to $25 per unit on the Dermabond,” he said, as opposed to between $2 and $5 for most sutures, although some specialty sutures can be much more expensive. Liquid stitches require less labor and time, however, which can offset the supply cost.

When purchased through a group purchaser, vein finders can be as inexpensive as $1,000 each, although they are usually in the realm of $11,000 to $15,000 apiece, according to Lori Pilla, vice president of strategic alliances, custom contracting, and clinical advantage at Amerinet, a group purchaser in St. Louis, Missouri.

Pilla said that avoiding pain is good for the bottom line. “The newer pain-reduction methods tend to be a little more expensive up front, but in the bigger picture, the total cost model, they save money.” Improved pain control can also lead to better HCAHPS scores, she added.

“You need to look at the total picture and the cost of delivering care. Reducing pain eventually reduces costs,” she said.

Source: HealthLeaders Media, December 10, 2015.

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