Interdisciplinary Management of Pain

Greater Baltimore Medical Center

Definitions

• Acute Pain: generally time-limited, and is responsive to opioid and non-opioid therapy

• Chronic Pain: exists beyond its expected time frame for healing or where healing may not have occurred; It is persistent pain that is not amenable to routine pain control methods

Pain Policy at GBMC

• All patients treated at GBMC will

receive appropriate analgesic care

• All patients treated at GBMC will be

assessed for the presence of pain, in

both inpatient and outpatient areas

Assessing Pain

• Patient’s self report will be the standard used in assessment

• Assessment begins on admission for pain and acceptable level of pain while hospitalized

• Pain is to be assessed/reassessed at the following intervals:− After any known pain producing event− With each new report of pain− Following therapeutic intervention− In accordance with the algorithms for acute and chronic pain− With the daily assessment (q8h) if pain is not present on

admission

Other Considerations

• All patients will be assessed q8h for any

associated symptoms of pain control therapy −nausea, itching, constipation, over-sedation, and

inability to void

• Placebo use for pain control is not allowed

• Patients and family should be educated on

the right to pain management, interventions

to relieve pain, and their role in managing

pain

Pain Consultative Services

• Department of Anesthesia will

consult for:−Acute Epidural Analgesia−PCA pumps

• Department of pediatrics will consult

on any patient under 16 years of

age

Pain Education• Patient education tools will be made available to all

patients upon admission− “What Patients and Families need to know about Pain

Management” (Form # 34680) − “What Parents need to know about Pain Management”

(Form # 34681)

• Nurse is responsible for assessing educational needs and developing and educational plan based on:− Plan of care− Patient goals− Culture− Age− Developmental Stage

Pain Screening Tools

• Visual Analogue Scales are used to screen patients

• For patients unable to self report, behavioral scales are used

• Non-English speaking patients are screened using language specific pain tools, an interpreter, or the assistance of the AT&T Language Line

• Pain Scales used at GBMC− Numbers scale (0-10) for adults− Faces scale for children 3 years and older− FLACC Scale for 3 months – 3 years− NPASS Scale for neonates

Pain Documentation

• Pain Assessment/Reassessment is documented in Meditech PCS − Admission Database − Pain Assessment/Reassessment Intervention

• Includes the following information:− Intensity of Pain− Description of Pain− Location of Pain− Aggravating / Alleviating Factors− Associated Signs / Symptoms− Impact on Functional Ability− Methods of pain management that have been useful in the

past− Patient’s personal goal for pain management

Pain Documentation

• Pain Reassessment is documented in Meditech PCS − Pain Assessment/Reassessment Intervention

• Reassessment occurs on the following

recommended intervals:− Oral Medications: within 60-90 minutes after dose administered− Intramuscular/Subcutaneous Medications: within 60-90

minutes after dose administered− Intravenous Medications: within 30-60 minutes after dose

administered

• Any pain medications administered are documented

on the MAR in Meditech

Patient Controlled Analgesia (PCA) Pumps• The CADD Prizm Pain Control System is used to deliver continuous (basal

rate) dosing and/or patient administered (bolus)doses.

• Two RNs are required to independently double check orders and

pump settings at each order change, change of shift, prior to transfer of

patients between units, and when receiving a patient upon arrival to the

unit

• PCA cassettes are supplied by pharmacy (found in AcuDose, delivered by

the pharmacy to unit, or picked up by the nurse at Pharmacy if not

premixed)

• PCA pumps are obtained from Central Sterile Supply

• All PCA documentation is entered into Meditech PCS in one of the following

interventions, as appropriate:− IV PCA Flowsheet (for Morphine and Dilaudid use)− Epidural PCA Flowsheet (for Epidural PCAs)− IV Fentanyl PCA Flowsheet (for Fentanyl use only)

More Information

• Please review the pain tools

document found on the

www.gbmc.org site – listed with the

Pain Self Learning Packet and test

• Please take the Pain SLP Test and

submit certificate of completion to

agency