SOUTHWEST COMMUNITY HEALTH SYSTEM POLICY GUIDELINE

Transcription

1 EFFECTIVE DATE: August, 2000 POLICY 739 Revision Dates: 10/01; 08/02; 11/02; 8/03; 9/04; 6/05; 8/05; 9/05; 10/05; Page 1 of 6 01/06; 11/06; 11/07; 10/08; 10/09; 12/11 Pain Management Flow Chart Pain Scales NIPS FLACC & Thermometer Scale POLICY NAME: PAIN MANAGEMENT I. PURPOSE: Southwest General Health Center will provide guidelines to ensure optimal patient comfort through a proactive pain control plan, which is mutually established with the patient, family/significant other, and health care team. II. POLICY STATEMENT: A. INTERPRETATION Pain can be a common part of the patient experience; unrelieved pain has adverse physical and psychological effects. To facilitate healing, comfort, and improve the quality of life, pain management at SWGHC is a collaborative process between the patient, physician, family/significant other, and all Health Center associates. All reports of pain are to be respected and every effort will be made to reduce pain to an acceptable level. III. DEFINITION OF TERMS: None IV. RESOURCES: None V. POLICY AUTHORITY: CNO VI. RELATED (SUPPORTING) POLICIES: VII. APPLICABILITY (Place an X next to all that apply) WHO: _x Associates Physicians Volunteers Others SITES: x ALL SITES (if not all check applicable sites) Brook Park Urgicare Brunswick Medical Center Commerce Park Health Center Main Campus Home Health Hospice Southwest General Medical Group Physicians Offices Other Jefferson Park Lifeworks Neighborhood Care Center Oakview Off Campus Business Locations Strongsville Medical Center

2 2 of VIII. IMPLEMENTATION PROCEDURES: OBJECTIVES An organizational approach to pain management ensures: A. A patient s right to effective pain management and involvement in their care. B. All patients will have a comprehensive pain assessment on admission that is consistent with the scope of care, treatment, and patient s condition. C. The hospital uses methods to assess pain that is consistent with the patient s age, condition, and ability to understand. D. The patient medical record will contain pain assessment, documentation of any intervention related to pain, and re-assessment of pain status within 60 minutes of every intervention. E. Patients and their families/significant other are educated about the need to communicate unrelieved pain. F. Utilization of pharmacological and non-pharmacological means to enhance quality of life and manage pain status. OVERSIGHT AND RESPONSIBILITY An interdisciplinary pain task force, co-chaired by an anesthesiologist, is responsible for establishing, implementing, and evaluating a coordinated organizational program for pain management. The Pain Committee meets at a minimum annually and as needed. It has oversight responsibility for assuring that all provisions of this policy are adhered to throughout the organization. The Pain Management Task Force will have representation from the following: 1. Medical Staff 2. Nursing Services 3. Social Services 4. Hospice 5. Pharmacy 6. Spiritual Care 7. Nursing Administration

3 3 of Performance Improvement 9. Others may be included as needed PATIENT CARE AREA A. SWGHC upholds a standard of care related to pain management, which is tailored to the specific needs of each patient care area according to its patient population. SPECIFIC ROLES AND RESPONSIBILITIES OF THE PATIENT CARE TEAM A. The Physician functions as leader of the patient care team and is responsible for directing the team in pain assessment, pharmacological and non-pharmacological treatment, minimizing drug side effects, and documentation in the medical record. B. Nursing s role and responsibilities to a patient s pain management is to: 1. Assess the patient s pain utilizing self-report and the pain assessment tool. 2. Implement measures to relieve pain. 3. Evaluate the effectiveness of pain relief interventions within 60 minutes of intervention. 4. Re-assess for ongoing pain and utilize an interdisciplinary team approach to meet the patient s needs per patient care area standard. 5. Provide early education for patients/significant others regarding alternative pain control measures, medicine administration, potential risks, and complications. 6. Document assessment and effectiveness of pain interventions. C. Spiritual Care responds to referrals from physician, nurse, and other staff to offer emotional support and spiritual care as needed through non-pharmacological interventions (e.g. guided meditation, relaxation techniques, spiritual direction, prayer). D. Social Services provides psychosocial support and intervention. E. Pharmacy provides pharmaceutical information and acts as a resource to patient, family, and patient care team members. PROCEDURE A. Pain Assessment Pain management is contingent upon appropriate pain assessment. The features of pain assessment include: 1. The patient s self-report of pain is to be accepted. Pain is a subjective experience and should be treated in a nonjudgmental manner as to the intensity and relief of pain.

4 4 of Please note if the patient is unable to report pain, the RN/LPN performing the assessment/evaluation will utilize the appropriate pain tool (FLACC or Thermometer scale, Form # X and NIPS for the Nursery). 3. A measure of pain intensity and a measure of pain relief will be recorded on a permanent record that facilitates regular review by members of the Patient Care Team. (Refer to form #156290X for approved pain scales) 4. Pain will be assessed on admission and every 8 hours and as needed except in ambulatory surgery, PACU, Pain Center, Emergency Room, Oakview and outpatients departments where documentation will occur per standards of the department. Initial pain assessment includes, but is not limited to, the following parameters: a. Location b. Intensity (numeric pain scale 0-10) c. Description (describe in patient s own words, e.g. dull, sharp, burning, patterns of radiation, etc.) d. Onset, duration, and variation e. Present pain management regimen and effectiveness f. Aggravating/alleviating factors g. Negative impacts (how does pain affect physical functions, sleep, moods, appetite, etc.) h. Pain history i. Patient s personal goal for pain relief. 5. Ongoing pain assessment is required to evaluate the changing nature of pain as well the effectiveness of the treatment plan. An assessment of pain should be done every 8 hours and reassessed within 60 minutes of intervention. The Patient Care Team will make appropriate adjustments in medication or pain management techniques, which allow for transition to discharge and continuing care at home. B. Interventions (Individualized to meet the Patient s needs) 1. Pharmacological Interventions a. Administer pain medication as ordered by Physician. i) Refer to nursing protocols if appropriate b. Re-assessment within 60 minutes of intervention and management of pharmacological side effects. 2. Non-Pharmacological Intervention a. Effective pain management includes non-pharmacological interventions as an adjunct to analgesic therapy. (These methods may enhance the patient s sense of control and add to the effectiveness of pharmacological interventions)

5 5 of C. Documentation b. Nursing, Physical Therapy, Occupational Therapy, Social Service, Spiritual Care, and Clinical Psychology may provide and evaluate nonpharmacological interventions. c. Interventions may include: i) Heat ii) Cold iii) Cutaneous stimulation iv) Relaxation v) Music therapy vi) Positioning. vii) Massage d. Reassessment of non-pharmacological intervention within 60 minutes of intervention is required. The Patient Care Team will document assessment on admission and per department policy. Documentation must include: Level of pain as reported by the patient, location of the pain, frequency, character, intervention and reassessment within 60 minutes of intervention. D. Education 1. Discuss with the patient and/or family/significant other, probable physiological causes of pain that might be specific to the patient (e.g., mass pressing on nerve, tumor obstructing bowel, etc.). 2. Educate patient on self-pain assessment and reporting utilizing appropriate pain scale, identifying location, aggravating factors and relieving factors. 3. Educate patient, family/significant other of pharmacologic interventions: a. Discuss medication actions, expected effects, and possible side effects. b. Discuss fears of addiction and drug tolerance. 4. Educate patient, family/significant other of non-pharmacologic interventions which may help prevent or alleviate pain (e.g., distraction, music, reading, prayer, meditation, guided imagery, massage therapy, etc.). 5. Involve the family and significant other regarding discharge instructions.

6 6 of Ongoing Health Center education for associates is provided to increase awareness and effective management of pain in their patients. PERFORMANCE IMPROVEMENT The Pain Management Task Force in conjunction with Nursing, Hospital and Medical Staff QI will monitor and evaluate compliance with the pain management policy, review processes and takes action on patient outcomes if needed. Performance Improvement monitoring will be based on American Pain Society Guidelines and monitoring tools will include patient surveys and medical record audits. RESOURCES Brennan et al Pain Management: A Fundamental Human Right, Anesthesia/Analgesia. Wisconsin Cancer Pain Initiative. (1997) Building an Institution Commitment to Pain Management M. McCaffrey, C. Pasero. (1999) Pain, Clinical Manual Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines, Acute Pain and Cancer Pain. City of Hope, MAYDAY Pain Resource Center The Joint Commission Standards American Pain Society Perry/Potter: Mosby 2006 APPROVED: Marti Bauschka Vice President and CNO Southwest General Health Center Thomas A. Selden President and CEO Southwest Community Health System