Presentation on theme: "Pain Management and Documentation"— Presentation transcript:
1 Pain Management and Documentation WhatWhenWhereProcedure changes and a refocus on quality patient pain managementNot control or even complete relief but addressed in a compassionate manner
2 PainPain is a symptom that signals distress in diverse populations of all agesPain – “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” International Association for the Study of PainPatients have the right to have their pain needs assessed and addressed. Nurses and physicians should be aware of these needs and work to relieve pain if possible.Look at the Patient Bill of rights
3 Self Report of PainPatients who are alert and have the ability to communicate appropriatelyAdults of all agesChildren about 5 years or more
4 Self Report of Pain Scale of 0-10 Faces 0 = no pain 10 = worst possible painGoogleFacesSmiling = no pain Crying = worst possible painPage C15Most common easy to use
5 Unable to Self ReportPain is difficult to measure when the patient is not able to tell you about their pain:UnconsciousAdvanced DementiaLimited cognitive abilityInfants under the age of 5 yearsUse PAINAD scale for dementia, unconscious patientsUse FLACC scale for children ages 0-5 years of age or children who cannot self-report
6 Unable to Self Report: FLACC Use on neonates, infants, and children to age 5Observe and recognize associated behavioral and physiologic responsesDifficult to recognizeLimit or avoid unnecessary noxious stimuli – acoustic, visual, tactilePage C15b
7 FLACC Scale Face Legs Activity Cry 1 2 Consol- ability Smiling or Smiling orrelaxedRelaxedLying quietlyNot cryingContent,1OccasionalgrimaceSquirmingSquirming and shifting back & forthMoans &whimpersReassured by occ. touching, hugging, distractable2Clenched jaw & quivering chinKickingArched, rigid, or jerkingCrying steadily, screams or sobsDifficult to console or comfort
8 Treatment Measures: Infants Comfort MeasuresSwaddling, pacifier, positioningOral administration of sucrose “sweetie”AnalgesiaSkilled personnel – venipuncture less painful than heel stick
9 Unable to Self Report: PAINAD Lack of ability to self reportCognitive disorder – cerebral palsy, head trauma, dementia, unconsciousRequires special consideration during assessment of painMultiple tools exist, but many have not been validated for reliability in a clinical setting
10 PAINAD ScaleThis tool, while developed primarily for use in patients with advanced dementia can be used in other patients who lack the ability to report their painAssesses five areasBreathing independent of vocalizationNegative vocalizationFacial expressionBody languageConsolablityScale:Page C15b
11 Smiling or inexpressive PAINAD Scale12ScoreBreathing independent of vocalizationNormalOcc. labored breathing. Short period of hyperventilationNoisy labored breathing. Long periods of hyper-ventilation. Cheyne-Stokes respirations.NegativevocalizationNoneOcc. moan or groan. Low level speech with a neg. or disapproving qualityRepeated trouble calling out. Loud moaning or groaning. Crying.Facial expressionSmiling or inexpressiveSad. Frightened. Frown.Facial grimacingBody LanguageRelaxedTense. Distressed pacing. Fidgeting.Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.ConsolabilityNo need to consoleDistracted or reassured by voice or touchUnable to console, distract, or reassure.Total
12 Surrogate Reporting of Pain Don’t forget the help that can come from a caregiver who really knows and understands patient’s behavior
13 When to AssessAll patients regardless of where they enter the healthcare setting should have their pain level assessed on admissionTriageAdmissionInpatientOutpatient
14 The NEXT AssessmentTiming of the next assessment varies based on location of care and needs of the patientInpatients (ICU, 2 East, 3 East)At least q 12 hours60 minutes post any intervention – medication, repositioning, etcAt discharge
15 ODA ED PACU On return from surgery 60 minutes post any intervention At discharge from ODAEDDetermined by category and patient conditionPACU2 – 20 minutes post any interventionDetermined by patient condition
16 Special Circumstances ODA and OR - Prior to surgery the nurse will check with anesthesia regarding need for pain relief due to the medication that will be given as sedation or anesthesia during actual procedureMBU – many obstetric patients receive an epidural catheter for pain relief during labor and deliveryThe catheter is placed by anesthesia and medication is delivered by anesthesia initially and placed placed on a pump for continued pain reliefNurses continue to assess patient’s pain needs at least q 1 hour
17 Patient Controlled Analgesia PCAOrdered by physicianConsult AnesthesiaDocument initial pain reliefAssess and document pain level at least q 2 hoursNOTE – PATIENT CONTROLLED ONLY
18 Barriers to Pain Management Attitudes, biasesMisinformation about addictionFear of legal problemsWorries about side effects
19 AddictionFewer than 2 in 10,000 patients with pain will become addicted to an opioid.
20 Patient Attitudes Afraid of addiction Misinformed “Strong” Remember to consider your patient’s cultural, religious, and social backgrounds
21 Education Discuss with patients and document their role in pain relief Pain should be reportedIf no relief, physician to be notifiedExpected painIntractable pain
22 If the patient says he/she is in pain…they are in pain. Remember….If the patient says he/she is in pain…they are in pain.
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