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Pain Management
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Joint Commission Standards
• All patients have the right to adequate pain management
• All patients must have their pain assessed and reassessed at
regular intervals
• There must be no barriers to pain management such as
language
• All patients should be educated about pain management and
be included in the plan of care for pain management
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Pain Assessment
• Pain assessment is done 3 times per day on the medical surgical
units, 4 times per day on cardiology and 6 times per day in
critical care areas.
• For patients who can self report pain, the 0 to 10 numeric pain
scale is used where 0 is not pain and 10 is the worst possible
pain.
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Pain Assessment in Non-verbal Patients
• For patients who cannot self report pain, the behavioral pain
scale (BPS) is used.
• This scale looks at behaviors such as facial, restlessness, muscle
tension, consolability and vocalization.
• These behaviors have been identified through research and the
American Geriatric Society (AGS, 2002) as indicating pain.
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Reassessment of Pain
• Reassessment is performed after every PRN opioid medication
to see if the intervention has been effective.
• After medication administration, reassessment is done at 30
minutes for IV and one hour for oral medications.
• A drop in pain intensity of two points or 30% is considered to be
a clinically significant change (Ferrar, 2001).
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The WHO Analgesic Ladder
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Medication Choices for Pain
• There is an acute pain management order set that shows which
formulary medications fall into the three different categories of
the WHO Analgesic Ladder.
• This order set can be accessed by going to SHIP, opening the
clinical forms section and clicking on acute pain order set.
• Choosing a pain medication that falls into the category of the
patient’s pain complaint will help address the patient’s pain.
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Other Order Sets
• There are standardized patient controlled analgesia (PCA)
orders for use by any physician or authorized healthcare
provider.
• There are standardized orders for epidural pain management
for use by anesthesia providers only
• An Interdisciplinary Pain Policy is also available online. The
policy details the practice of pain management at Suburban
Hospital.
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Support for Pain Management
• There is an Anesthesia Pain Service that consults for acute pain
issues. It is available 24/7,365 days a year. The on-call MD can
be reached by providing a pain consult order or by calling the
anesthesia MD, who is on call for the week.
• The pain schedule is posted on most nursing units or the
operator can call the on-call pain MD for you.
• There is a Pain Management Nurse Practitioner who works
Monday through Friday. She can see patients during the day
while anesthesia providers are in the OR.
• You can page the NP at 576 or leave a message at 301-8963765.
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