Download pain management - Empire Quality Partnership

PAIN MANAGEMENT
Carole Morgan, RN, MPA, LNHA
Director of Nursing
Patrick O’Toole, Pharm. D., MPA
Director of Pharmacy
Sea View Hospital Rehabilitation Center and Home
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PAIN
 Number 1 complaint among older adults
 Nearly 60% of older adults taking pain
medications
 Can significantly affect ones well being
 A barrier in treating pain in older adult is
inadequate pain assessment
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ASSESSMENT
What’s Needed
 A comprehensive tool to capture both
subjective/objective on admission, readmission,
significant change or a new onset of pain
 Anticipation of Pain – before dressing changes,
Rehab therapy, ROM exercises
 Assessment tool must also identify
Residents needs and goals
Etiology
Severity
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ASSESSMENT
 Subjective data
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Onset – location and time
or origin
Contributing factors –
Causes of pain beginning
or worsening
Quality – Description
(sharp, dull, crushing,
aching, burning, steady,
movable)
Intensity – Severity on a
scale of 1 – 10
Pattern – how often, how
long, certain times
Relief measures –
measures to relieve or
control pain
 Objective data

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Appearance - Evidence of
clenched teeth or fists clenched,
swelling, deformity, redness,
perspiration, tense muscles,
change in pupil size, fatigue
Movements – Evidence of
guarded movements, rigidity,
restlessness, restriction of use
Affect – Evidence of mood
changes, signs of anger,
irritability, or depression
Vital signs – Change in pulse,
blood pressure, respiration
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Monitoring
Once a resident is identified as having
pain, we begin a fluid and on-going
process of evaluation of treatment
modalities, to see
if they are effective
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Interdisciplinary Treatment
 Attention must not only be directed at physiological
aspects of addressing pain but also consider
providing alternate treatments that focus upon
psychosocial and environmental factors
 ITC team and resident collaborate to arrive at a
measurable treatment goals
 Often, trials of various treatment modalities are
needed to develop the most effective approach
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Interdisciplinary Measures
 Movies:
Comedies - LAUGHTER releases endorphins which
act like “Natural Opiates” to the body so that pain
severity actually diminishes and even disappears for
a period of time
 Environmental:
Adjusting room temperature, lighting, smoothing out
linens, comfortable bedding, and using alternating air
mattresses
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Interdisciplinary Measures
Relaxation Techniques:
 Guided Imagery
 Muscle Relaxation
 Reiki
Aromatherapy:
Increasingly used as part of an integrated approach to pain.
Touch and smell affect the parasympathetic nervous
system, that can induce deep state of relaxation and this in
turn can alter patients perception of pain. Specific aromatherapy
contains pharmacological active ingredients which can benefit pain
sufferers
 Oil from lavender and peppermint have been beneficial in reducing
pain.
 Vanilla to stimulate appetite
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Interdisciplinary Measures
 Range Of Motion exercises to maintain joint
motion and relieve stiffness
 Endurance exercises (e.g.) cycling, aerobic
exercise can decrease inflammation
 Walking – Pain from cancer or Neurological
(Neuropatic pain) benefits to keep things
moving
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Interdisciplinary Measures
PET THERAPY - Studies show that pets reduce
blood pressure, provide comfort and unconditional
acceptance
MUSIC – Used for centuries to promote physical and
emotional healing
 Music brings harmony back to the whole self; it is a
powerful distraction and promotes relaxation
 Music competes with pain signals to the brain
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OTHER APPROACHES
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WRITING
TALKING ON THE PHONE
PLAYING CARDS
CRAFT PROJECTS
READING
HOT AND COLD PACKS
COUNSELING
MASSAGE
SOCIAL SUPPORT
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PAIN MANAGEMENT
Pharmacological Therapy (Medication)

Scheduled dosing instead of PRN

Start with short acting medication – once pain
control is achieved, change to long acting meds
with short acting PRN med for breakthrough pain

Assess patient’s response to medication
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Case Snapshot
 MR 83 years old, female
 DX: Dementia, DM, Depression, HTN, S/P CVA, OA
 Meds: Metformin 500 mg. twice a day, Norvasc 10
mg daily, Trazodone 50 mg. at bedtime, Zocor 20 mg.
at bedtime, Plavix 75 mg daily, Acetaminophen 650
mg every 6 hours for OA pain
 Continue to complain of pain
 MD change Acetaminophen to Percocet 5/325 mg.
every 6 hours
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Case Snapshot, cont.
After a week , new issues noted

Episodes of falls

Change in mental status

Uncooperative with Rehab/ADLs

Constipation
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Case Snapshot, cont.
Interventions

Taper dose of Percocet, re-start to
Acetaminophen for OA pain

Encourage participation with Activities - Pet
therapy, Music, aromatherapy

Use of hot packs, cold packs to knees

Use topical pain relieving cream
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Case Snapshot, cont.
 Continue to have discomfort (pins and
needles sensations) in extremities
 Intervention changed Trazodone to Cymbalta
to address for Neuropathic pain
 Continue Acetaminophen for OA pain
 Percocet discontinued
 Resident more cooperative and active with
Rehab
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Staff Education
 Identification: Direct care and ancillary staff are often the
first to recognize symptoms
 Assessment: Review of current standards of practice,
and policy
 Discussion on cultural barriers and individual perceptions
 Interdisciplinary Modalities: Pain Management including
non - pharmacological approach
 Evaluation of program
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RIGHT INTERVENTIONS WITH THE
RIGHT RESIDENT
INDIVIDUALIZED
And
MAY NEED TO BE MODIFIED
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For Additional Information
Carole Morgan, RN
(718) 317-3612
[email protected]
Patrick O’Toole, Pharm.D.
(718) 317-3308
[email protected]
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Resources on Pain
Assessment and Management
www.americangeriatrics.org/education/cp_index.shtml
www.amda.com/tools/guideline.cfm
www.cms.hhs.gov/surveycertificationgeninfo/downloads/scletter09-2.pdf
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