Menu Offers à la Carte Pain Management Therapies

One of the most frustrating scenarios for bedside nurses is when they respond to a call light, the patient asks for more pain medication and the nurse must tell the patient it’s too soon. Fortunately, Cleveland Clinic nurses have a host of alternate therapies to alleviate pain. And a duo of nurses on a post-operative cardiovascular unit teamed with a clinical nurse specialist to create a “comfort menu” to ensure nurses, patients and their families know about all the options.

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“Staff nurses weren’t aware of all the non-pharmacological therapies Cleveland Clinic offers – music therapy, art therapy, Reiki and so on – to help patients relax and get comfortable,” says Kathy Isaacson, BSN, RN, who works on the unit. “The comfort menu provides a way to get the information out.”

Last year, Isaacson worked with Karen Brown, RN, and Jennifer Colwill, MSN, APRN, CCNS, PCCN, to develop the comfort menu. The handout allows patients to select from a variety of therapies, ranging from massage and Reiki to relaxation videos and music channels. It encourages patients to use alternate therapies in conjunction with ordered medications to reduce pain, improve comfort and lessen anxiety.

The comfort menu was rolled out during a three-month pilot last fall. It was clipped to the front of admission folders and placed on whiteboards within each room. In addition, nurses were urged to call attention to the comfort menu. “We want to encourage patients, along with families, to be more in control of pain management,” says Brown.

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After implementation, Isaacson, Brown and Colwill surveyed 30 patients on the use and benefits of the comfort menu and therapy choices. Sixty percent of the patients were aware of the menu and felt it was beneficial to promote comfort. More than half turned to the comfort menu for relaxation options, while others sought relief from pain (17 percent), sleeplessness (17 percent) or anxiety (14 percent). Two popular therapy choices were self-directed, with 18 percent of patients opting to listen to the music channel and 15 percent watching relaxation videos.

Fifteen nurses also were surveyed: Two-thirds said they used the comfort menus and the same number said it increased their awareness of non-pharmacologic therapies. Isaacson, Brown and Colwill published their findings in a poster presentation at the Patient Experience: Innovation + Empathy Summit, hosted by Cleveland Clinic in May.

Perhaps more compelling than the numbers, however, is the anecdotal evidence. Brown was pleasantly surprised at how often aroma therapy and music therapy were used. (Nine percent and 12 percent, respectively, according to survey results.) And alternate therapies continue to be requested on the post-op cardiovascular unit.

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In June, Brown asked a patient during rounds if there was anything she could do for him. He quipped, “You could get me a live band.” Brown did the next best thing: She contacted a music therapist, who came to unit later that day and spent two hours playing her keyboard and singing songs with the patient and his wife. “They were ecstatic,” says Brown. “It totally changed his mood. He was happy and smiling.”