Post on 24-Sep-2020
Nursing Orientation
PAIN
“Pain is whatever the experience person
says it is, existing whenever he/she says
it does.” Margo McCaffery MS, FAAN, RN 1996
IMPACT ON QUALITY OF LIFE
Anxiety
Emotional Distress
Undermines well-being
Interferes with functional capacity
Hinders the ability to fulfill family, social, and vocational roles.
Diminished strength and endurance
Depression
Difficulty Concentrating
Disruptive sleep
Nausea/poor appetite
Diminished enjoyment in life
PAIN ASSESSMENT
When
On Admission, Q8hrs, Q1/2 hr post IV pain med, Q1 hr post oral pain med, and as needed
How
Pain Scale and beyond
Why
It is the right thing to do
Improve patient satisfaction
Prevent long term pain complications
Education
Patient education is so important
Patients have the right to have their pain assessed and managed effectively.
BEYOND THE PAIN SCALE
Quality
Location
Alleviating and Aggravating Factors
Impact on Quality of Life
Setting a Pain Goal Scale of 1-10
Participate in Physical Therapy
Perform ADLs
Sleep
Walk to the Bathroom etc…..
PAIN TREATMENT
Pharmacologic Opiods, NSAIDS, Cox II Inhibitors, Steroids, Anti-
Depressants, and Anti-Convulsants
Long acting vs. short acting
Non-Pharmacologic Heat, Ice, Braces, Massage, Accupuncture, Distraction,
Music, Humor, Smoking, etc…
Multi-Model Therapy Using more than one type of treatment to manage pain
Education
Pain Education is a Joint
Commission Requirement!
PATIENT CONTROLLED ANALGESIA
(PCA)
Routes for PCA
How PCA works
Assessment
Education
Documentation
Special Considerations
PCA…A pain management method in which patients control delivery of pain medication.
REGIONAL ANALGESIA
AKA Nerve Blocks
- anesthetic or anti-inflammatory injection.
- targets certain nerve groups
Used for both inpatients and outpatients
Non-Opiod
Allows for early ambulation and therapy
Minimal side effects
Special Considerations
EPIDURAL ANALGESIA
What is it?
Epidural Orders
Nursing Assessment
Documentation
Special Considerations
PAIN SPECIAL CONSIDERATIONS
Narcotization
Addiction
Tolerance
TOLERANCE VS. ADDICTION
Tolerance: The capacity of the body to
endure or become less responsive to a
substance.
Addiction: When a person obtains a
substance illegally and uses that
substance for a purpose other than what it
was prescribed/intended for.
PATIENTS WITH DRUG ADDICTIONS
Encourage Doctors, Residents, and Nurse
Practitioners to consult Psych and/or Pain
Clinic
HOSPITAL CONSUMER ASSESSMENT OF
HOSPITAL PROVIDERS AND SYSTEMS
(HCAHPS)
National Standard for collecting and public reporting of patient perspective of hospital care.
Seven Domains Communication with Nurses
Communication with Doctors
Responsiveness of staff
Environment
Pain Management
Communication about medication
Discharge information
HOSPITAL CONSUMER ASSESSMENT OF
HOSPITAL PROVIDERS AND SYSTEMS
(HCAHPS)
12. During your hospital stay did you need medicine for pain? Yes
No, if no go to question 15
13. During your hospital stay how often was your pain well-controlled? Never
Sometimes
Usually
Always
14. During your hospital stay how often did the staff do everything they could to help with your pain? Never
Sometimes
Usually
Always
PRESS GANEY
Not mandatory
In addition to HCHAPS
Patient Satisfaction Survey Question
How well was your pain managed?
CONDITION H CALLS
The Condition H (Help) program provides a
hotline for hospital patients and their family
members to call when there is:
a noticeable, clinical change in the patient
and the health care team is not present or
not responding to the patient’s or visitors’
concerns
a breakdown in how care is being managed
or confusion about the care plan
IT’S NOT JUST ABOUT THE MEDICATION
Customer service can go along way!
The communication and relationship that
we build with the patients is “Key”.
Remember patients are rating us on
their perception of the care that they
received.
Pain Management is not just about the
medication: it’s offering ice, heat,
repositioning, music, education, etc…