Pain Management FINAL

Creating Better PainManagement through ClinicalSimulationHollie AdejumoHoward High School

What is Pain?An "unpleasant sensory andemotional experienceassociated with actual orpotential tissue damage, ordescribed in terms of suchdamage.“-The International Association for theStudy of Pain http://health.howstuffworks.com/diseases-conditions/pai

Types of Pain Acute or Transient pain Chronic or Persistent Pain Cancer Pain http://health.howstuffworks.com/diseases-conditions/headache/10- types-of-headaches.htm

Methods of Managing Pain• Internal Procedures• Medication• Therapy• Alternative Therapies• Counseling and Support Acupuncture is a common alternative method for relieving pain http://health.howstuffworks.com/wellness/natural-medicine/chinese/acupuncture.htm

Measuring Pain“Pain is whatever the experiencing patient says it is, existing when she/he says it does” –McCaffery and Pasero (1999) Patient’s Perspective: ◦ Demands physical, emotional, and mental energy Provider’s Perspective: ◦ Assessed by looking at a patient’s report, not the predicted signs and symptoms ◦ Patients tells if pain is present and what it is like

Types of Pain Medication Non-Opioid Analgesics Opioid Analgesics

Effective Pain Management http://www.wllc.com/blog/preventing-medication-errors.cfm Combine opioid and non-opioid pharmaceuticals Timely administration

Patient Concerns Psychological Dependence Drug Tolerance Physical Dependence Addiction

Effective Pain Management andConsiderations Understand a patient’s cultural differences in pain expression ◦ Different cultures may have different ideas of the meaning of pain Assess the meaning of pain to a patient

Pain Assessment Tools OPQRSTU Pain Scales http://savvypatient.org

OPQRSTU of PainAssessmentO nsetP rovocative/Palliative FactorsQ uality (Open Ended Questions)R egion/RadiationS everityTimingU You “How does pain affect you?”

Pain Scales Numerical Rating Wong-Baker Verbal Rating Observer Scales

Numerical Rating Scale http://understandingpain.wordpress.com/category/pain-assessment-tools/

Wong-Baker Scale http://understandingpain.wordpress.com/category/pain-assessment-tools/

Verbal Rating Scale- McGill PainQuestionnaire http://pain.about.com/od/testingdiagnosis/ig/pain-scales/McGill-Pain-Scale.htm

Observer Pain Scales http://0.tqn.com/d/pain/1/0/V/-/-/-/FLACC.gif

Using Pain Scales to MakeDecisions about Pain Medication Pain Scales make the pain measurable Helps to determine if pain is mild, moderate, or severe Makes it easier to find an effective dose

Factors Considered whenDetermining Medication Dosage • History of a patient’s pain • Pain intensity • Duration of Pain • Aggravating and Relieving Conditions • Determine the cause of the pain

Clinical Simulation-BasedTraining “Simulation is a technique – not a technology – to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” – David M. Gaba, Stanford University Examples: ◦ Standardized Patients ◦ Mannequins ◦ Computer-Based Simulation Used to build a safer health system by providing guided practice http://blog.hospitalclinic.org/en/2009/05/nou-laboratori-de-simulacio- clinica-de-la-facultat-de-medicina/

Benefits of Clinical Simulation http://www.temple.edu/ics/programs/medicine/fy2.html• Provides a variety of real-life situations• Opportunity to repeatedly practice without real patients• Convenient• Active learning and Concentration• Increases collaboration within medical teams

Standardized Patient •An actor trained to portray the role of a patient, family member, or another individual •Simulate in a standardized mannerhttp://www.temple.edu/ics/about/standardized.html http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index. html

Resident Problems with OpioidDecision Making Lack of Confidence Poor Interviewing Technique Lack of Opioid Knowledge Poor written orders for medication Inconsistent use of drug calculations to determine drug doses

Improving Opioid DecisionMaking with Clinical Simulation-Based Training Goals: ◦ To improve physician confidence when working with a patient experiencing pain ◦ To use drug calculations when making opioid decisions ◦ To write appropriate orders http://zotzine.uci.edu/2009_04/patient.php

Assessing a Patient with Pain • Describe the Pain Scale Appropriately • Ask patient of history of addiction • Discuss addiction vs. dependence • Ask about opioid related side effects • Assess for constipation • Address the fear of addiction • Make correct doses

Results More comfortable with making dosage decisions Increase in confidence http://blog.soliant.com/doctor-and-physician-salary- ranges-average-salaries-and-educational- requirements/ More frequent use of opioid conversions Not much effect on writing appropriate orders

Improving Results in the Future  Continuous education and regular review will continue to improve resident physician skillshttp://www.thedoctorweighsin.com/%E2%80%9Ctake-this-medication-okay-taking-a-look-at-emergency-department-discharge-instructions/

Acknowledgements I would like to thank Ms. Emily Shaw, Ms. Kat Walker, and all of the other staff at the Simulation Center for helping to make this project possible

http://www.sitel.org	354
http://siteldev.dnsalias.com	18
http://translate.googleusercontent.com	1

Pain Management FINAL

by hadejumo on Nov 18, 2011

Accessibility

Categories

Upload Details

Usage Rights

3 Embeds 373

Statistics

Pain Management FINAL — Presentation Transcript