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Interdisciplinary Management of Pain. Greater Baltimore Medical Center. Definitions. Acute Pain : generally time-limited, and is responsive to opioid and non-opioid therapy

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Interdisciplinary Management of Pain

Greater Baltimore Medical Center


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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


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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


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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:

    • 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


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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


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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


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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:

    • Plan of care

    • Patient goals

    • Culture

    • Age

    • Developmental Stage


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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

    • 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


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Pain Documentation

  • Pain Assessment/Reassessment is documented in Meditech PCS

    • Admission Database

    • Pain Assessment/Reassessment Intervention

  • Includes the following information:

    • 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


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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


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Patient Controlled Analgesia (PCA) Pumps

  • The CADD Prizm Pain Control System is used to deliver continuous (basal rate) dosing and/or patient administered (bolus)doses.

  • 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

  • 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)

  • PCA pumps are obtained from Central Sterile Supply

  • 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)


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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


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