Download Pain Management clinical protocol MMC.docx

Nurse Practitioner
CLINICAL PROTOCOL
Pain management
Murray Medical Centre Mandurah will adopt the following guidelines from the RACGP:
1. Medical Care of older persons in Residential Aged Care facilities: pain
management.
NOTE:
References to the prescription and administration of Schedule 8 medication in any of
these protocols are outside the scope of practice of a Nurse Practitioner. Patients requiring
these medications will be referred to their current GP for further advice and treatment
options.
Goals of Treatment
• Relief of symptoms
•
Prevention of recurrence
•
Prevention of complications
Drug Formulary
FORMULARY
PARACETAMOL
Drug (generic name): Paracetamol
Drug: Ibuprofen
IBUPROFEN
Therapeutic class: Analgesic, antipyretic
Therapeutic class: Analgesic, antipyretic, NSAID (non -
Dosage range: 500mg – 1G
selective)
Route: Oral
Dosage range: 200-400mg
Frequency of administration: 4-6 hourly, max 4G in 24 hours
Route: Oral
Duration of order: as required
Frequency of administration: 6 hourly, max 2400mg in 24
Contraindications for use: nil – caution in pt. with liver disease
hours
Adverse drug reactions: Rare – rash, drug fever, mucosal
Duration of order: as required
lesions, neutron/pancyto/thrombocytopenia
Contraindications: care with asthmatic pts., may reduce the
antiplatelet activity of aspirin (choose an alternative if long term
therapy required).
Adverse drug reactions: bronchospasm, GI bleeding,
nausea, HT
Nurse Practitioner
CLINICAL PROTOCOL
Pain management
PANADOL OSTEO
Drug: paracetamol
PANADEINE FORTE
Drug: Paracetamol and Codeine
Therapeutic class: Slow release analgesic, antipyretic
Therapeutic class: non-opioid analgesic
Dosage range: 665mg / tab. 2 tablets. Max 3990mg/day
Dosage range: paracetamol 500mg / codeine 30mg per
Route: Oral
tablet. 1-2 tabs, max 8 tablets daily
Frequency of administration: 6-8 hourly
Route: Oral
Duration of order: As required
Frequency of administration: 4-6 hourly if required
Contraindications: chronic liver disease
Duration of order: as required
Adverse drug reactions: Rare – rash, drug fever, mucosal
Contraindications: chronic liver disease
lesions, neutron/pancyto/thrombocytopenia,
Adverse drug reactions: Rare – rash, drug fever, mucosal
lesions, neutron/pancyto/thrombocytopenia, drowsiness,
dizziness.
VOLTAREN
NAPROXEN
Drug: Diclofenac
Drug:NSAID
Therapeutic class: NSAID - nonselective
Therapeutic class: Analgesic, anti –inflammatory, antipyretic.
Dosage range: 75mg – 150mg daily (in divided doses), max
Dosage range: 250mg – 500mg OR 750mg-1000mg SR
200mg/day.
Route: Oral
Route: Oral
Frequency of administration: Twice daily OR SR - daily
Frequency of administration: 2-3 times daily
Duration of order: As required
Duration of order: As required
Indications: Rheumatoid arthritis, osteoarthritis, acute gout,
Indications: Rheumatoid arthritis, osteoarthritis, soft tissue
pain due to inflammation.
and inflammatory pain.
Contraindications: May increase risk of bronchospasm or
Contraindications: increased cardiovascular risk.
cardiovascular events, not advised in pts. with active GI
Adverse drug reactions: GIT bleeding, oedema, HT, CCF,
bleeding.
bronchospasm
Adverse drug reactions: GIT bleeding, oedema, HT, CCF,
bronchospasm
Nurse Practitioner
CLINICAL PROTOCOL
Pain management
BUSCOPAN
Drug: hyoscine Butylbromide
ENDEP
Drug: Amitriptyline
Therapeutic class: analgesic, anticholinergic, antispasmodic.
Therapeutic class: Tricyclic antidepressant.
Mode of action: reduces GI motility and spasm, smooth
Dosage range: 10-25mg nocte, titrate to a maximum of 150mg
muscle relaxant.
for pain
Dosage range: 10mg-20mg
Route: Oral
Route: Oral
Frequency of administration: daily at night
Frequency of administration: 3 – 4 times daily.
Duration of order: as required.
Duration of order: As required
Indications: Neuropathic pain
Indications: GI spasm, renal/biliary spasm
Contraindications: closed angel glaucoma, hyperthyroidism,
Contraindications: GI or urinary obstruction, myasthenia
Adverse drug reactions: Anticholinergic effects, hypotension,
gravis, closed angle glaucoma.
tachycardia, hyperglycaemia, gynaecomastia, breast
Adverse drug reactions: Generally dose related. Dry mouth,
enlargement and galactorrhoea in females.
constipation, dry eyes.
Unexpected
representation
NP Clinical
Practice
Evaluative strategies
Review Patient Notes. Full audit clinical
events.
NP Clinical Practice/Medical Report Audit
Key Terms
NP – Nurse Practitioner
CP – Clinical Protocol
GP – General Practitioner
S4 – Schedule of the drug administration
act
References
1. Australian Medicines handbook (2011). Australian Medicines Handbook Pty Ltd, SA;
2011
2. etg complete (internet). Melbourne: Therapeutic Guidelines Limited; 2011 Nov.
Accessed 2011 Dec 15th at http://etg.tg.com.au/ref/ref
3. RACGP (2011). Medical care of older persons in Residential Aged Care Facilities: Pain
management. Accessed 20 Dec 2011 at: www.racgp.org.au
Nurse Practitioner
CLINICAL PROTOCOL
Pain management
Authorship, Endorsement and acknowledgement
This CP was originally written by:
Reviewed and authorised by:
Carol Jones
Dr. Frank Reedman Jones
Nurse Practitioner
MBBCh, DCH, DRCOG, FRACGP, FACRRM
Murray Medical Centre Mandurah
Murray Medical Centre: Primary Care
Physician
We acknowledge the authorship of:
Dr. Eileen Bristol
MBChB,MRCGP,DRCOG,FRACGP
Murray Medical Centre: Primary Care
Physician
Carol Jones
RN, RM, PGradDipNursePractitioner, NP
Nurse Practitioner
Date Written: December 2011
Review Date: December 2013