Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

A. Original Tools from Contributors to this Issue:

Some of the following tools are downloadable Adobe Acrobat PDF files. If you do not have Adobe Acrobat Reader and wish to download a free copy you may do so at the Adobe website.

Click on the "Back" button to return to this page after accessing each PDF file.

1. Tools from the Medical College of Wisconsin Palliative Care Program:

©2000 MCW Research Foundation
Permission granted to modify or adopt provided written credit is given to the Medical College of Wisconsin. Published here with permission.

Nursing leaders in Wisconsin Long Term Care Coalition to Improve Pain Management believed there was a need for an educational tool that could guide nurses through the analgesic management of pain. Based upon a complete pain assessment, algorithms were designed to guide nurses through the pharmacological and non-pharmacological management of pain. To see the algorithms, click on the highlighted terms which follow. Pain is categorized as Mild (1-3), Moderate (4-6), or Severe (7-10). Using the algorithms, the nurse can suggest appropriate interventions for management of the resident's pain.

b. Guidelines for Analgesic Drug Orders

MCW researchers developed these guidelines to help agencies formulate their own policies and procedures about the use of analgesics.

2. Tools from Franciscan Woods, Covenant Healthcare:

©2000 Franciscan Woods, Covenant Healthcare
The following tools are published here with permission.

a. Pain Management Flow Sheet

b. Subacute and Extended Care: Pain Management Guidelines

B. Opioid Converter Online at Cynergy Group founded by Anna and Stuart Du Pen of Du Pen, Inc.:
http://www.cynergygroup.org
The Opioid Conversion Calculator is a tool for determining equi-analgesic doses of opioid drugs. Viewers can input the patient's current regimen, specify a drug to convert to, and the calculator gives you an equivalent dose of the new drug. A wide variety of drugs and routes can be specified. The Calculator is a synthesis of widely-accepted equivalencies, recent information reported in the literature, clinical experience, and collaboratively-acquired expert opinions. The site has also tried to include distilled "best practice" recommendations where possible. Go to the following page for disclaimer and proceed to the opioid converter: http://www.cynergygroup.org/cgi-bin/calc/disclaimer.asp

C. Websites related to this issue's contributors:

End-of-Life Physician Education Resource Center (EPERC)
http://www.eperc.mcw.edu/
The purpose of EPERC is to assist physician educators and others in locating high quality, peer-reviewed training materials. This website supports the identification and dissemination of information on end-of-life training materials, publications, conferences, and other opportunities. EPERC is supported by The Robert Wood Johnson Foundation and located at the Medical College of Wisconsin.

Mayday PainLink
http://www.edc.org/PainLink/
An extensive list of annotated links to pain-related websites can be found at http://www.edc.org/PainLink/plweb.html. Mayday PainLink is a virtual community of institutions and practitioners committed to improving their pain management practices developed by staff at the Center for Applied Ethics and Professional Practice at EDC in Newton, MA and funded by the Mayday Fund. The site has both public and members only sections. Members have access to a variety of resources including technical assistance, e-mail discussions, on-line events and the PainLink Clinician Survey.

Palliative Medicine Program at the Medical College of Wisconsin
http://www.mcw.edu/pallmed
This site offers a variety of educational services and information for health care professionals about pain management and end-of-life care.

Wisconsin Cancer Pain Initiative: A World Health Organization Demonstration Project
www.wisc.edu/wcpi/wcpihome.htm
The "Making Pain Management a priority in all health care settings" page includes a short description of the Medical College of Wisconsin Long-Term Care Pain Management program featured in this issue of Innovations. The WCPI is a member of the American Alliance of Cancer Pain Initiatives. Viewers can click on a map to look up their state's initiative.

D. Other Relevant Websites

American Association of Homes and Services for Aging
http://www.aahsa.org/
The American Association of Homes and Services for the Aging (AAHSA) represents nonprofit organizations dedicated to providing high-quality health care, housing and services to the nation's elderly. The website includes information on the organization, its resources and programs.

The American College of Health Care Administrators
http://www.achca.org
A professional society dedicated to advancing the standards of long-term care-from skilled nursing to assisted living to subacute care.

American Medical Directors Association
http://www.amda.com/
This is a national professional organization committed to the continuous improvement of the quality of patient care by providing education, advocacy, information, and professional development for medical directors and other physicians who practice in long-term care. Viewers can enter "pain management" into search feature to create a list of documents that can be downloaded, including "CNA Retention—What the Medical Director Can Do to Help."

American Pain Society
http://www.ampainsoc.org/
The mission of the American Pain Society is to serve people in pain by advancing research, education, treatment and professional practice. APS is a nonprofit membership society and welcomes broad participation from all disciplines. Resources include the most recent information on public policy updates, reference tools, and advances in pain management.

American Society of Consultant Pharmacists
http://www.ascp.com

Cancer Pain Release
http://www.medsch.wisc.edu/WHOcancerpain
This publication of the World Health Organization Collaborating Center for Policy & Communications in Cancer Care now posts back issues online. The most recent issue, "Resources for patient education about pain relief in cancer" Vol 13, No. 3-4, 2000 offers an invaluable listing of books, videos, websites, CD-roms, and audiotapes in English, French and Spanish. It is currently only available in hard copy. You may subscribe from the website, however.

Center for Community Change
http://www.communitychange.org
An organization committed to helping poor people improve their communities and change policies and institutions that affect their lives by developing their own strong organizations. This site has specific pages with resources devoted to "Changing Policies" as well as "Building Organizations" that may be of particular interest to pain management change agents.

Community-State Partnerships to Improve End-of-Life Care
http://www.midbio.org/npopolicybrief.htm
This page lists policy briefs, which can be downloaded. Issues 5, 6, 7 & 8 focus on improving long-term care. Issue 5: "Promising Educational Initiatives for Staff, Regulators, and Families" is of particular interest. Community-State Partnerships is housed at the Midwest Bioethics Center in Kansas City, Missouri. Myra Christopher, president and CEO of Midwest Bioethics Center, is national director of the Community-State Partnerships program. A grant program funded by The Robert Wood Johnson Foundation, Community-State Partnerships to Improve End-of-Life Care, has awarded $11.25 million to 23 broad-based, multidisciplinary coalitions working to promote policy change and support for high-quality, comprehensive end-of-life care.

The John A. Hartford Foundation Institute for Geriatric Nursing
http://www.nyu.edu/education/nursing/hartford.institute/
This site includes a Best Practices page, which includes a segment called "Try This Series." Each issue focuses on a particular topic (geriatric depression, pain assessment, cognitive impairment) reviews a sample tool for assessing this domain. The tools are posted and can be downloaded; see for example, "Assessing Pain in Older Adults" includes the visual analog scale and a faces scale for measuring pain intensity.

International Association for the Study of Pain (IASP)
http://www.halcyon.com/iasp/
Pain: Clinical Updates the IASP newsletter, is available on the web at http://www.halcyon.com/iasp/PCUOpen.html.
The IASP site also offers extensive links to other resources for dealing with pain at: http://www.halcyon.com/iasp/ressopen.html.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Pain Standards for 2001
http://www.jcaho.org/standards_frm.html

National Association Directors of Nursing Administration/Long Term Care
http://www.nadona.org
Of particular interest are archived articles from The Director found at www.nadona.org/director.html These include a three-part series on the evolving role of CNAs, as well as a short piece on pain: Pain On Hold!

Wong-Baker FACES Pain Rating Scale
www.harcourthealth.com/Mosby/Wong/hcom_wong_face.html
Explanation of the development of this popular pain rating scale as well as a version that can be downloaded and necessary permission forms to complete if users wish to use the scale.