Transcript Interdisciplinary Management of Pain

Interdisciplinary Management
of Pain
Greater Baltimore Medical Center
Definitions
• Acute Pain: generally time-limited, and
is responsive to opioid and non-opioid
therapy
• Chronic Pain: exists beyond its expected
time frame for healing or where healing
may not have occurred; It is persistent
pain that is not amenable to routine pain
control methods
Pain Policy at GBMC
• All patients treated at GBMC will receive
appropriate analgesic care
• All patients treated at GBMC will be
assessed for the presence of pain, in
both inpatient and outpatient areas
Assessing Pain
• Patient’s self report will be the standard used in
assessment
• Assessment begins on admission for pain and
acceptable level of pain while hospitalized
• Pain is to be assessed/reassessed at the following
intervals:
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After any known pain producing event
With each new report of pain
Following therapeutic intervention
In accordance with the algorithms for acute and chronic pain
With the daily assessment (q8h) if pain is not present on admission
Other Considerations
• All patients will be assessed q8h for any
associated symptoms of pain control therapy
− nausea, itching, constipation, over-sedation, and
inability to void
• Placebo use for pain control is not allowed
• Patients and family should be educated on the
right to pain management, interventions to
relieve pain, and their role in managing pain
Pain Consultative Services
• Department of Anesthesia will consult
for:
− Acute Epidural Analgesia
− PCA pumps
• Department of pediatrics will consult on
any patient under 16 years of age
Pain Education
• Patient education tools will be made available to all
patients upon admission
− “What Patients and Families need to know about Pain
Management” (Form # 34680)
− “What Parents need to know about Pain Management” (Form #
34681)
• Nurse is responsible for assessing educational needs
and developing and educational plan based on:
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Plan of care
Patient goals
Culture
Age
Developmental Stage
Pain Screening Tools
• Visual Analogue Scales are used to screen patients
• For patients unable to self report, behavioral scales
are used
• Non-English speaking patients are screened using
language specific pain tools, an interpreter, or the
assistance of the AT&T Language Line
• Pain Scales used at GBMC
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Numbers scale (0-10) for adults
Faces scale for children 3 years and older
FLACC Scale for 3 months – 3 years
NPASS Scale for neonates
Pain Documentation
• Pain Assessment/Reassessment is documented in
Meditech PCS
− Admission Database
− Pain Assessment/Reassessment Intervention
• Includes the following information:
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Intensity of Pain
Description of Pain
Location of Pain
Aggravating / Alleviating Factors
Associated Signs / Symptoms
Impact on Functional Ability
Methods of pain management that have been useful in the past
Patient’s personal goal for pain management
Pain Documentation
• Pain Reassessment is documented in Meditech PCS
− Pain Assessment/Reassessment Intervention
• Reassessment occurs on the following recommended
intervals:
− Oral Medications: within 60-90 minutes after dose administered
− Intramuscular/Subcutaneous Medications: within 60-90 minutes
after dose administered
− Intravenous Medications: within 30-60 minutes after dose
administered
• Any pain medications administered are documented on
the MAR in Meditech
Patient Controlled Analgesia (PCA)
Pumps
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The CADD Prizm Pain Control System is used to deliver continuous (basal
rate) dosing and/or patient administered (bolus)doses.
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Two RNs are required to independently double check orders and pump
settings at each order change, change of shift, prior to transfer of patients
between units, and when receiving a patient upon arrival to the unit
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PCA cassettes are supplied by pharmacy (found in AcuDose, delivered by the
pharmacy to unit, or picked up by the nurse at Pharmacy if not premixed)
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PCA pumps are obtained from Central Sterile Supply
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All PCA documentation is entered into Meditech PCS in one of the following
interventions, as appropriate:
− IV PCA Flowsheet (for Morphine and Dilaudid use)
− Epidural PCA Flowsheet (for Epidural PCAs)
− IV Fentanyl PCA Flowsheet (for Fentanyl use only)
More Information
• Please review the pain tools document
found on the www.gbmc.org site – listed
with the Pain Self Learning Packet and
test
• Please take the Pain SLP Test and submit
certificate of completion to agency