Medicine ��� Divisions
Hospital Pain Policy and Procedure with References
POLICY AND PROCEDURE MANUAL
DEPARTMENT: Administration ISSUE NO. 831-200-169
EFFECTIVE DATE: 3/01/01 SUPERSEDES DATE: 3/22/99
SUBJECT:
Pain Assessment and Management
REFERENCE
AHRQ Guidelines, Agency for Health Care
Research and Quality, Pub 92-0032, Feb, 1992; Pub 94-0592, March, 1994
JCAHO Standards RI.1.2;RI.1.2.8; PE.1.4;TX.3.3;TX.5.4
PE.1.7; CC.6.1; PI.3.1; JCAHO Manual
WHO Three Step Analgesic Ladder
PCA Policy 601-100-0935
Epidural Policy 601-100-0936
PURPOSE:
Effective pain assessment and management can remove the adverse psychological and physiological effects of unrelieved pain. Optimal management of the patient experiencing pain enhances healing and promotes both physical and psychological wellness. Patients need to be involved in all aspects of their care including pain management.
RESPONSIBILITY:
The Chief Executive Officer, the Chief Operating Officer, Medical Director, Chiefs of Service, and the Executive Director of Nursing are to ensure compliance with this policy.
The Medical Staff, Advanced Practice Nurses, Education Specialists, Physician Assistants, Directors of Patient Care Services, Director of Ambulatory Care Services, Patient Care Coordinators, Nurse Managers/designee shall ensure that this policy and/or procedure is implemented as outlined.
The MD or licensed provider and the RN and LPN are responsible for implementing this procedure as outlined.
POLICY:
It is the policy of University Hospital to respect and support the patient's right to optimal pain assessment and management when it does not interfere with the need for observation or is the discomfort associated with pregnancy. It is the responsibility of all clinical staff to assess and periodically reassess the patient for pain and relief from pain including the intensity and quality and responses to treatment.
Assessment/Management
1) At the time of admission to the nursing unit or ambulatory setting the patient will be questioned regarding pain during the initial nursing/physician assessment. Pain will be assessed at each encounter using the appropriate patient type assessment in the Emergency Department and in the Ambulatory Service area for all patients. Appropriate scales will be selected according to developmental needs and/or cognitive impairment. The patient will be instructed on the method of evaluating pain using the 0-10 scale. The FACES pain rating scale will be used for the pediatric, non-English speaking patients or any patient with limited communication.
1.1 The presence of pain will be identified by or referred to the physician for the appropriate management. A patient report of 5/10 or higher on the pain scale or the FACES scale should elicit an intervention.
1.2 The pain assessment will be documented in the patient's record.
2) The physician of record/designee will assess pharmacologic or non-pharmacologic interventions utilizing the AHRQ Guidelines (Attachment A) and the WHO Three Step Analgesic Ladder. (Attachment B)
2.1 The Pain Management Service may be consulted by the physician of record for assistance with pharmacological interventions. (Beeper (973) 312 - 0709 )
2.2 All members of the health care team will have access to the Pain Help Team. This team can be called for questions/problems related to the pharmacological and non pharmacological management of a patient's pain. (Beeper (973) 312 - 0709 )
3) The RN will assess pain at least once every 8 hours and again prior to the administration of any analgesic. Also, within 30 minutes following the administration of an intravenous analgesic and within 60 minutes following the administration of an oral analgesic utilizing the 0-10 visual analog scale for adults and the FACES scale for children (Attachment C). Appropriate scales will be used for neonatal assessment. This assessment will be documented on the applicable flow sheet.
3.1 The physician of record/designee will identify medication to be administered
and
write orders for medication administration indicating route, dose and frequency.
3.2 Nursing will administer prescribed medication at the stated intervals and document effect on pain.
3.3 If the patient's report of pain is rated >5 at 30 minutes following the administration of IV pain medication or 60 minutes following the administration of oral medication the nurse is to notify the physician and discuss additional pain interventions.
4. Questions related to pain may include, but are not limited to:
· Nature of pain
· Duration
· Type
· Intensity
· Any pain relief methods that have proven effective
· Patient's desire for pain management, i.e. pain control, complete pain
relief.
5. The patient and his/her family/significant other will receive education provided by the staff regarding management of the patient's pain. (Attachment D) Education includes, but is not limited to:
· Rights regarding pain assessment and management
· Pain control mechanisms available and/or have been employed
· Potential limitation of pain management and treatment
· Types of pain the patient may experience
· Potential and actual side effects of pain management and treatment
· Discharge planning process with emphasis on symptom management.
6. All patient care providers will provide information to the patient and the patient's family/significant others emphasizing that the optimal management of pain is a primary goal of patient care, and is consistent with the organization's mission.
Staff Competency
1. Each department is responsible for developing staff competencies related
to pain theory, assessment/documentation and interventions used by that discipline.
2. Attending physicians and housestaff receive appropriate information and training
related to pain assessment and management.
Management of Pain at Discharge
1. Discharge planning will be initiated at the time of admission, and appropriate
referrals will be provided as needed.
2. The patient/family will be educated about effective pain/symptom management
and the resources that are available upon discharge.
Monitoring
Existing mechanisms/tools for data collection and monitoring will be utilized to determine the effectiveness/outcome of the patient's pain management.