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Embedding a Palliative Approach In Residential Settings (EPAIRS)

Embedding a Palliative Approach In Residential Settings (EPAIRS). Pain – assessment and management. Steps. See – recognize and assess pain Say – report what you see Do – manage the pain (within your scope) Report – your actions Review – reassess: is it working?.

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Embedding a Palliative Approach In Residential Settings (EPAIRS)

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  1. Embedding a Palliative Approach In Residential Settings (EPAIRS) Pain – assessment and management

  2. Steps See – recognize and assess pain Say– report what you see Do – manage the pain (within your scope) Report – your actions Review – reassess: is it working? Adapted from the Residential Aged Care Palliative Approach Toolkit (2012)

  3. SEE -What is pain? An unpleasant sensory and emotional experience • Pain is whatever the resident says it is • Residents with cognitive impairment are less likely to get pain medication. • VCH RAI indicators: • 15.6% of residents have moderate daily pain or severe pain • 11.2% of residents have worsened pain compared to the last assessment

  4. Untreated pain can lead to: • Delirium • Decreased sleep • Decreased activity • Decreased function • Decreased quality of life • Social Isolation, Anxiety, Depression • Potential for Hyperalgesia

  5. Unable to communicate (e.g. moderate to severe dementia, language barrier)? PAINAD

  6. Able to communicate (even with mild dementia)? Ask resident NOPPAIN

  7. SAY: reporting what you see • Be as specific as you can • When did it start? • Where is the pain? • At rest or with movement? • How often? • Report immediately if it is severe or gets worse

  8. DO: managing the pain What are some ways to reduce pain besides medication? • Positioning: lying and sitting • Massage • Heat • Relaxation, deep breathing • Complementary therapies • Distraction (music, movies, visitors)

  9. DO: Pharmacological Around the clock dosing is key to good pain control – PRN rule - >3 in 48 hrs. • Non-opioids (e.g. Tylenol, Ibuprofen, ASA) • Opioids (e.g. Dilaudid, Oxycodone, or Fentanyl) • Facts and myths: Tolerance, physical dependence and addiction.

  10. Report: share with team members RCA – Report to nurse • What interventions did you try? Have you seen a change in the resident? • Have you talked with family? • Have you noticed any side effects? Nurse – chart note; report to GP • Pain assessment tool used? • Interventions tried? Changes in resident? • Report from RCA, resident, family?

  11. Review: reassess • Not just once, but ongoing • Repeat same assessment tool overtime • Continue to share what you see and do with team members. • Remember pain prevention

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