Nursing Assessment of the Nursing Assessment of the New Chronic Pain PatientNew Chronic Pain Patient

Sr. C WakefieldSr. C Wakefield

Clinical Nurse specialistClinical Nurse specialist

In Chronic Pain In Chronic Pain managementmanagement

Baguley Pain Unit- Baguley Pain Unit- Wythenshawe HospitalWythenshawe Hospital

University Hospitals University Hospitals of South of South Manchester NHS Manchester NHS Foundation TrustFoundation Trust

BackgroundBackground

Sister on NSU Hope Hospital for 12 yearsSister on NSU Hope Hospital for 12 years

Trained as Associate Pain Nurse Specialist Trained as Associate Pain Nurse Specialist

for Neurosurgeryfor Neurosurgery

Acute Pain Sister at Warrington Gen 3yearsAcute Pain Sister at Warrington Gen 3years

CNS Chronic Pain at NMGH for 3yearsCNS Chronic Pain at NMGH for 3years

CNS Chronic Pain present post for 4 yearsCNS Chronic Pain present post for 4 years

My Role - ManagerMy Role - Manager

Coordinator of MDTCoordinator of MDT

Manage day to day running of unitManage day to day running of unit

Nurse Manager – team 6 nursesNurse Manager – team 6 nurses

Manage administrative team Manage administrative team

Assist with budget/target/waiting list Assist with budget/target/waiting list managementmanagement

My Role - ClinicalMy Role - Clinical Run 2 nurse led drug/procedure Run 2 nurse led drug/procedure

review clinicsreview clinics

Run opiate review clinicRun opiate review clinic

Run primary care based chronic Run primary care based chronic pain service – Tier 2pain service – Tier 2

First contact for patients and First contact for patients and hospital staffhospital staff

Audit research and educationAudit research and education

New Patient Triage – Tier 2New Patient Triage – Tier 2

All primary care referralsAll primary care referrals

Directory Services Directory Services

Triage new patientsTriage new patients

Direct referrals from other Tier 2 Direct referrals from other Tier 2

servicesservices

Links with GP’s Links with GP’s

Tier 2 - LimitationsTier 2 - Limitations

Limited treatmentsLimited treatments

Lone practitionerLone practitioner

No PsychologistNo Psychologist

Limited review appointmentsLimited review appointments

Tier 2 philosophy treat and Tier 2 philosophy treat and

dischargedischarge

Nurse Assessment of New Nurse Assessment of New PatientsPatients

ControversialControversial

Based Good TriageBased Good Triage

Not dissimilar to consultant Not dissimilar to consultant

assessmentassessment Good explanationGood explanation Treatment goalsTreatment goals HonestHonest Accept own limitationsAccept own limitations

AssessmentAssessment

Structured AssessmentStructured Assessment

Back to front Back to front

Patient understands reasons for ?Patient understands reasons for ?

More openMore open

Personally - get more out of patients Personally - get more out of patients

Continuity of careContinuity of care

Social HistorySocial History

Relationship statusRelationship status Family statusFamily status Hobbies & interestsHobbies & interests WorkWork Social lifeSocial life Alcohol & SmokingAlcohol & Smoking Recreational DrugsRecreational Drugs

24hr Day24hr Day

Time awakeTime awake Time upTime up Activities of daily livingActivities of daily living Spend day Doing?Spend day Doing? Housework CookingHousework Cooking Retire to bedRetire to bed Sleep patternSleep pattern

Previous Medical HistoryPrevious Medical History

Illness’s Illness’s

OperationsOperations

Long term conditionsLong term conditions

Family historyFamily history

Current medicationsCurrent medications

Psychological HistoryPsychological History

History of depressionHistory of depression

Family history of depressionFamily history of depression

History of anxiety disordersHistory of anxiety disorders

Significant events Significant events

Personality disordersPersonality disorders

Previous medicationPrevious medication

Psychological scoresPsychological scores

Pain HistoryPain History

How longHow long Onset of Pain/ CauseOnset of Pain/ Cause DescriptionDescription VAS score – best & worseVAS score – best & worse Better withBetter with Worse withWorse with Past treatmentsPast treatments

RED Flags!RED Flags!

Previous history Previous history caca

Night sweatsNight sweats Age <20 & > 55Age <20 & > 55 Bladder & BowelBladder & Bowel Thoracic painThoracic pain OnsetOnset

Weight lossWeight loss Co-morbidityCo-morbidity Recent Recent

infectioninfection Progressive Progressive

neurological neurological deficitdeficit

TraumaTrauma

ExaminationExamination

PosturePosture

Range of movementRange of movement

PowerPower

ReflexesReflexes

Sensory changesSensory changes

Obvious abnormalitiesObvious abnormalities

DiscussionDiscussion

Patients model for their painPatients model for their pain

Clinicians modelClinicians model

Explanation nature chronic painExplanation nature chronic pain

Pacing goal setting and exercisingPacing goal setting and exercising

Treatment optionsTreatment options

Tier 2 - TreatmentsTier 2 - Treatments

Education and CounsellingEducation and Counselling

Physiotherapy – acupuncture, Physiotherapy – acupuncture,

hydrohydro

TENSTENS

Pharmacological txPharmacological tx

Direct list to secondary care for Direct list to secondary care for

injections/MDT/PMPinjections/MDT/PMP

Tier 2 TreatmentsTier 2 Treatments

Referral PsychologyReferral Psychology

Referral to other tier 2 servicesReferral to other tier 2 services

Referral to other specialitiesReferral to other specialities

Follow up and supportFollow up and support

Refer on to secondary careRefer on to secondary care

CNS CompetenciesCNS Competencies

No Clear GuidanceNo Clear Guidance

BPS guidelines 2002 - withdrawnBPS guidelines 2002 - withdrawn

Job description/titleJob description/title

Key Skills framework Key Skills framework

New Guidelines 2008 BPS RCN New Guidelines 2008 BPS RCN

CNS CompetenciesCNS Competencies

RGN RGN

Post reg courses relevant to Post reg courses relevant to

subjectsubject

3 yrs experience senior level 3 yrs experience senior level

Masters level degree ? PainMasters level degree ? Pain

?Nurse prescribing?Nurse prescribing

Management experienceManagement experience

ConfidentConfident