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Pain Management and Documentation What When Where.

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Presentation on theme: "Pain Management and Documentation What When Where."— Presentation transcript:

1 Pain Management and Documentation What When Where

2 Pain Pain is a symptom that signals distress in diverse populations of all ages Pain – “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 Pain

3 Self Report of Pain Patients who are alert and have the ability to communicate appropriately Adults of all ages Children about 5 years or more

4 Self Report of Pain Scale of 0-10 – 0 = no pain 10 = worst possible pain Google  Faces – Smiling = no pain Crying = worst possible pain

5 Unable to Self Report Pain is difficult to measure when the patient is not able to tell you about their pain: – Unconscious – Advanced Dementia – Limited cognitive ability – Infants under the age of 5 years Use PAINAD scale for dementia, unconscious patients Use 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 5 Observe and recognize associated behavioral and physiologic responses Difficult to recognize Limit or avoid unnecessary noxious stimuli – acoustic, visual, tactile

7 FLACC Scale FaceLegsActivityCry Consol- ability 0 Smiling or relaxed RelaxedLying quietlyNot cryingContent, relaxed 1 Occasional grimace SquirmingSquirming and shifting back & forth Moans & whimpers Reassured by occ. touching, hugging, distractable 2 Clenched jaw & quivering chin KickingArched, rigid, or jerking Crying steadily, screams or sobs Difficult to console or comfort

8 Treatment Measures: Infants Comfort Measures – Swaddling, pacifier, positioning – Oral administration of sucrose “sweetie” – Analgesia – Skilled personnel – venipuncture less painful than heel stick

9 Unable to Self Report: PAINAD Lack of ability to self report Cognitive disorder – cerebral palsy, head trauma, dementia, unconscious Requires special consideration during assessment of pain Multiple tools exist, but many have not been validated for reliability in a clinical setting

10 PAINAD Scale This tool, while developed primarily for use in patients with advanced dementia can be used in other patients who lack the ability to report their pain Assesses five areas – Breathing independent of vocalization – Negative vocalization – Facial expression – Body language – Consolablity Scale:

11 PAINAD Scale 012Score Breathing independent of vocalization Normal Occ. labored breathing. Short period of hyperventilation Noisy labored breathing. Long periods of hyper- ventilation. Cheyne- Stokes respirations. Negative vocalization None Occ. moan or groan. Low level speech with a neg. or disapproving quality Repeated trouble calling out. Loud moaning or groaning. Crying. Facial expression Smiling or inexpressive Sad. Frightened. Frown. Facial grimacing Body Language Relaxed Tense. Distressed pacing. Fidgeting. Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out. Consolability No need to console Distracted or reassured by voice or touch Unable 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 Assess All patients regardless of where they enter the healthcare setting should have their pain level assessed on admission – Triage – Admission – Inpatient – Outpatient

14 The NEXT Assessment Timing of the next assessment varies based on location of care and needs of the patient Inpatients (ICU, 2 East, 3 East) – At least q 12 hours – 60 minutes post any intervention – medication, repositioning, etc – At discharge

15 ODA – On return from surgery – 60 minutes post any intervention – At discharge from ODA ED – 60 minutes post any intervention – Determined by category and patient condition PACU – 2 – 20 minutes post any intervention – Determined 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 procedure MBU – many obstetric patients receive an epidural catheter for pain relief during labor and delivery – The catheter is placed by anesthesia and medication is delivered by anesthesia initially and placed placed on a pump for continued pain relief – Nurses continue to assess patient’s pain needs at least q 1 hour

17 Patient Controlled Analgesia PCA – Ordered by physician – Consult Anesthesia – Document initial pain relief – Assess and document pain level at least q 2 hours NOTE – PATIENT CONTROLLED ONLY

18 Barriers to Pain Management Attitudes, biases Misinformation about addiction Fear of legal problems Worries about side effects

19 Addiction Fewer 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 reported – If no relief, physician to be notified – Expected pain – Intractable pain

22 Remember…. If the patient says he/she is in pain…they are in pain.

23 Pain Management must be a Team Effort!


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