Pain Management

PAIN

• Kidney Stone Pain

• Pain of any Origin

Kidney Stone Pain

• Abrupt onset of severe, unrelenting flank or lower abdominal pain

• Pain may remain localized or may radiate into the lower abdomen or genital region

• Patient is very restless, since no position affords any pain relief

• Other signs and symptoms include nausea & vomiting, frequent urination, painful urination, abdominal pain, chills, fever and hematuria

Pain Management

• An interdisciplinary approach to making pain manageable, optimizing function and maximizing quality of life.

• Strategies include:Drug interventionsNon drug interventions

Objectives

• Reduce the incidence and severity of patients’ acute post procedure pain.

• Educate patients about the need to communicate unrelieved pain so they can receive prompt evaluation and effective treatment.

• Enhance patient comfort and satisfaction.

Pain Assessment Scale

• Scale– Numeric Rating 0 -

10– Faces– Non-English Speaking

Patients– Pediatric Patients

0 1 2 3 4 5 6 7 8 9 10

0= No Pain

1-2= Mild Pain

3-4= Discomforting

5-6= Moderate Pain

7-8= Distressing

9-10=Severe Pain

Assessing Pain

• Pre-Procedure Phone Call

• Day of Procedure

• Post Procedure Phone Call

Pre-Procedure• Phone Call

3-4 Days Pre-ProcedureMedical HistorySurgical HistoryCurrent MedicationsUrological HistoryPresent Symptoms Policy C.22.A (Pre-Procedure Call)

Day of Procedure

• Peri-Operative Nursing AssessmentStatus day of procedurePain Score Aldrete Scoring System Discharge Instructions

• Anesthesiologist AssessmentPain medication if necessary Policy C.40.A (Anesthesia General Policy)

Post Procedure

• Phone Call24 – 48 Hours Post ProcedurePain ScoreFollow-upPatient SurveyPost ESWL Follow-UpPolicy C.23.A (Post Procedure Call)

Joint Commission Standards

• RI.1.2.7 – Patients have the right to appropriate assessment and management of pain.

• PF.2.5 – Pain management as a part of treatment.

Joint Commission Standards

• P.E.1.4 – Pain is assessed in all patients.

• TX.5.4.6 – The Patient is monitored throughout the post procedure period, with specific attention to pain intensity, quality and responses to treatment.

What to Document?

• Location

• Quality

• Onset/duration

• Frequency/Intensity

• Present pain management regimen and effectiveness

Patient Education• Videos

• Brochure– Pain Management Techniques For Patients

• Discharge Instructions

• Family or other caregivers

• Policy C. 22. A & C. 23. A Pre and Post Procedure Phone Calls

• Policy C.24.A (Patient Education)

• Policy C.27.A (Lithotripsy Procedure)

Staff Education

• Orientation

• Inservice

No pain or pain at a tolerable levelNo pain or pain at a tolerable level

ReassessReassess

No pain or pain at a tolerable levelNo pain or pain at a tolerable level

DischargeDischarge

Procedure (Anesthesia and AnalgesiaProcedure (Anesthesia and Analgesia))

Pre-Procedure Patient AssessmentPre-Procedure Patient Assessment

Significant painSignificant pain

Drug and nondrug interventionDrug and nondrug intervention

Assess effect of interventionAssess effect of intervention

No pain reliefNo pain relief

Change drug/doseChange drug/dose

No pain or pain at a tolerable levelNo pain or pain at a tolerable level

Discharge – Discharge – Transfer to HospitalTransfer to Hospital

Patient/FamilyPatient/Family EducationEducation

Post ProcedurePost Procedure

Post Procedure PhonePhone Calll

No pain reliefNo pain relief