Nursing Assessment of the New Chronic Pain Patient Sr. C Wakefield Clinical Nurse specialist In Chronic Pain management

Baguley Pain Unit- Wythenshawe Hospital University Hospitals of South Manchester NHS Foundation Trust

Background Sister on NSU Hope Hospital for 12 years Trained as Associate Pain Nurse Specialist for Neurosurgery Acute Pain Sister at Warrington Gen 3years CNS Chronic Pain at NMGH for 3years CNS Chronic Pain present post for 4 years

Sister on NSU Hope Hospital for 12 years

Trained as Associate Pain Nurse Specialist for Neurosurgery

Acute Pain Sister at Warrington Gen 3years

CNS Chronic Pain at NMGH for 3years

CNS Chronic Pain present post for 4 years

My Role - Manager Coordinator of MDT Manage day to day running of unit Nurse Manager – team 6 nurses Manage administrative team Assist with budget/target/waiting list management

Coordinator of MDT

Manage day to day running of unit

Nurse Manager – team 6 nurses

Manage administrative team

Assist with budget/target/waiting list management

My Role - Clinical Run 2 nurse led drug/procedure review clinics Run opiate review clinic Run primary care based chronic pain service – Tier 2 First contact for patients and hospital staff Audit research and education

Run 2 nurse led drug/procedure review clinics

Run opiate review clinic

Run primary care based chronic pain service – Tier 2

First contact for patients and hospital staff

Audit research and education

New Patient Triage – Tier 2 All primary care referrals Directory Services Triage new patients Direct referrals from other Tier 2 services Links with GP’s

All primary care referrals

Directory Services

Triage new patients

Direct referrals from other Tier 2 services

Links with GP’s

Tier 2 - Limitations Limited treatments Lone practitioner No Psychologist Limited review appointments Tier 2 philosophy treat and discharge

Limited treatments

Lone practitioner

No Psychologist

Limited review appointments

Tier 2 philosophy treat and discharge

Nurse Assessment of New Patients Controversial Based Good Triage Not dissimilar to consultant assessment Good explanation Treatment goals Honest Accept own limitations

Controversial

Based Good Triage

Not dissimilar to consultant assessment

Good explanation

Treatment goals

Honest

Accept own limitations

Assessment Structured Assessment Back to front Patient understands reasons for ? More open Personally - get more out of patients Continuity of care

Structured Assessment

Back to front

Patient understands reasons for ?

More open

Personally - get more out of patients

Continuity of care

Social History Relationship status Family status Hobbies & interests Work Social life Alcohol & Smoking Recreational Drugs

Relationship status

Family status

Hobbies & interests

Work

Social life

Alcohol & Smoking

Recreational Drugs

24hr Day Time awake Time up Activities of daily living Spend day Doing? Housework Cooking Retire to bed Sleep pattern

Time awake

Time up

Activities of daily living

Spend day Doing?

Housework Cooking

Retire to bed

Sleep pattern

Previous Medical History Illness’s Operations Long term conditions Family history Current medications

Illness’s

Operations

Long term conditions

Family history

Current medications

Psychological History History of depression Family history of depression History of anxiety disorders Significant events Personality disorders Previous medication Psychological scores

History of depression

Family history of depression

History of anxiety disorders

Significant events

Personality disorders

Previous medication

Psychological scores

Pain History How long Onset of Pain/ Cause Description VAS score – best & worse Better with Worse with Past treatments

How long

Onset of Pain/ Cause

Description

VAS score – best & worse

Better with

Worse with

Past treatments

RED Flags! Previous history ca Night sweats Age <20 & > 55 Bladder & Bowel Thoracic pain Onset Weight loss Co-morbidity Recent infection Progressive neurological deficit Trauma

Previous history ca

Night sweats

Age <20 & > 55

Bladder & Bowel

Thoracic pain

Onset

Weight loss

Co-morbidity

Recent infection

Progressive neurological deficit

Trauma

Examination Posture Range of movement Power Reflexes Sensory changes Obvious abnormalities

Posture

Range of movement

Power

Reflexes

Sensory changes

Obvious abnormalities

Discussion Patients model for their pain Clinicians model Explanation nature chronic pain Pacing goal setting and exercising Treatment options

Patients model for their pain

Clinicians model

Explanation nature chronic pain

Pacing goal setting and exercising

Treatment options

Tier 2 - Treatments Education and Counselling Physiotherapy – acupuncture, hydro TENS Pharmacological tx Direct list to secondary care for injections/MDT/PMP

Education and Counselling

Physiotherapy – acupuncture, hydro

TENS

Pharmacological tx

Direct list to secondary care for injections/MDT/PMP

Tier 2 Treatments Referral Psychology Referral to other tier 2 services Referral to other specialities Follow up and support Refer on to secondary care

Referral Psychology

Referral to other tier 2 services

Referral to other specialities

Follow up and support

Refer on to secondary care

CNS Competencies No Clear Guidance BPS guidelines 2002 - withdrawn Job description/title Key Skills framework New Guidelines 2008 BPS RCN

No Clear Guidance

BPS guidelines 2002 - withdrawn

Job description/title

Key Skills framework

New Guidelines 2008 BPS RCN

CNS Competencies RGN Post reg courses relevant to subject 3 yrs experience senior level Masters level degree ? Pain ?Nurse prescribing Management experience Confident

RGN

Post reg courses relevant to subject

3 yrs experience senior level

Masters level degree ? Pain

?Nurse prescribing

Management experience

Confident