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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

Interdisciplinary Management of Pain

Greater Baltimore Medical Center

definitions
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
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
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
other considerations
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
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
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
pain screening tools
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
pain documentation
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
pain documentation10
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
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)
more information
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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