pain management - Empire Quality Partnership
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Transcript pain management - Empire Quality Partnership
PAIN MANAGEMENT
Carole Morgan, RN, MPA, LNHA
Director of Nursing
Patrick O’Toole, Pharm. D., MPA
Director of Pharmacy
Sea View Hospital Rehabilitation Center and Home
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PAIN
Number 1 complaint among older adults
Nearly 60% of older adults taking pain
medications
Can significantly affect ones well being
A barrier in treating pain in older adult is
inadequate pain assessment
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ASSESSMENT
What’s Needed
A comprehensive tool to capture both
subjective/objective on admission, readmission,
significant change or a new onset of pain
Anticipation of Pain – before dressing changes,
Rehab therapy, ROM exercises
Assessment tool must also identify
Residents needs and goals
Etiology
Severity
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ASSESSMENT
Subjective data
Onset – location and time
or origin
Contributing factors –
Causes of pain beginning
or worsening
Quality – Description
(sharp, dull, crushing,
aching, burning, steady,
movable)
Intensity – Severity on a
scale of 1 – 10
Pattern – how often, how
long, certain times
Relief measures –
measures to relieve or
control pain
Objective data
Appearance - Evidence of
clenched teeth or fists clenched,
swelling, deformity, redness,
perspiration, tense muscles,
change in pupil size, fatigue
Movements – Evidence of
guarded movements, rigidity,
restlessness, restriction of use
Affect – Evidence of mood
changes, signs of anger,
irritability, or depression
Vital signs – Change in pulse,
blood pressure, respiration
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Monitoring
Once a resident is identified as having
pain, we begin a fluid and on-going
process of evaluation of treatment
modalities, to see
if they are effective
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Interdisciplinary Treatment
Attention must not only be directed at physiological
aspects of addressing pain but also consider
providing alternate treatments that focus upon
psychosocial and environmental factors
ITC team and resident collaborate to arrive at a
measurable treatment goals
Often, trials of various treatment modalities are
needed to develop the most effective approach
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Interdisciplinary Measures
Movies:
Comedies - LAUGHTER releases endorphins which
act like “Natural Opiates” to the body so that pain
severity actually diminishes and even disappears for
a period of time
Environmental:
Adjusting room temperature, lighting, smoothing out
linens, comfortable bedding, and using alternating air
mattresses
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Interdisciplinary Measures
Relaxation Techniques:
Guided Imagery
Muscle Relaxation
Reiki
Aromatherapy:
Increasingly used as part of an integrated approach to pain.
Touch and smell affect the parasympathetic nervous
system, that can induce deep state of relaxation and this in
turn can alter patients perception of pain. Specific aromatherapy
contains pharmacological active ingredients which can benefit pain
sufferers
Oil from lavender and peppermint have been beneficial in reducing
pain.
Vanilla to stimulate appetite
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Interdisciplinary Measures
Range Of Motion exercises to maintain joint
motion and relieve stiffness
Endurance exercises (e.g.) cycling, aerobic
exercise can decrease inflammation
Walking – Pain from cancer or Neurological
(Neuropatic pain) benefits to keep things
moving
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Interdisciplinary Measures
PET THERAPY - Studies show that pets reduce
blood pressure, provide comfort and unconditional
acceptance
MUSIC – Used for centuries to promote physical and
emotional healing
Music brings harmony back to the whole self; it is a
powerful distraction and promotes relaxation
Music competes with pain signals to the brain
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OTHER APPROACHES
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WRITING
TALKING ON THE PHONE
PLAYING CARDS
CRAFT PROJECTS
READING
HOT AND COLD PACKS
COUNSELING
MASSAGE
SOCIAL SUPPORT
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PAIN MANAGEMENT
Pharmacological Therapy (Medication)
Scheduled dosing instead of PRN
Start with short acting medication – once pain
control is achieved, change to long acting meds
with short acting PRN med for breakthrough pain
Assess patient’s response to medication
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Case Snapshot
MR 83 years old, female
DX: Dementia, DM, Depression, HTN, S/P CVA, OA
Meds: Metformin 500 mg. twice a day, Norvasc 10
mg daily, Trazodone 50 mg. at bedtime, Zocor 20 mg.
at bedtime, Plavix 75 mg daily, Acetaminophen 650
mg every 6 hours for OA pain
Continue to complain of pain
MD change Acetaminophen to Percocet 5/325 mg.
every 6 hours
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Case Snapshot, cont.
After a week , new issues noted
Episodes of falls
Change in mental status
Uncooperative with Rehab/ADLs
Constipation
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Case Snapshot, cont.
Interventions
Taper dose of Percocet, re-start to
Acetaminophen for OA pain
Encourage participation with Activities - Pet
therapy, Music, aromatherapy
Use of hot packs, cold packs to knees
Use topical pain relieving cream
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Case Snapshot, cont.
Continue to have discomfort (pins and
needles sensations) in extremities
Intervention changed Trazodone to Cymbalta
to address for Neuropathic pain
Continue Acetaminophen for OA pain
Percocet discontinued
Resident more cooperative and active with
Rehab
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Staff Education
Identification: Direct care and ancillary staff are often the
first to recognize symptoms
Assessment: Review of current standards of practice,
and policy
Discussion on cultural barriers and individual perceptions
Interdisciplinary Modalities: Pain Management including
non - pharmacological approach
Evaluation of program
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RIGHT INTERVENTIONS WITH THE
RIGHT RESIDENT
INDIVIDUALIZED
And
MAY NEED TO BE MODIFIED
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For Additional Information
Carole Morgan, RN
(718) 317-3612
[email protected]
Patrick O’Toole, Pharm.D.
(718) 317-3308
[email protected]
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Resources on Pain
Assessment and Management
www.americangeriatrics.org/education/cp_index.shtml
www.amda.com/tools/guideline.cfm
www.cms.hhs.gov/surveycertificationgeninfo/downloads/scletter09-2.pdf
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