Pain Management (Physicians)


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Pain Management (Physicians)

  1. 1. Pain Management
  2. 2. PAIN <ul><li>Kidney Stone Pain </li></ul><ul><li>Pain of any Origin </li></ul>
  3. 3. Kidney Stone Pain <ul><li>Abrupt onset of severe, unrelenting flank or lower abdominal pain </li></ul><ul><li>Pain may remain localized or may radiate into the lower abdomen or genital region </li></ul><ul><li>Patient is very restless, since no position affords any pain relief </li></ul><ul><li>Other signs and symptoms include nausea & vomiting, frequent urination, painful urination, abdominal pain, chills, fever and hematuria </li></ul>
  4. 4. Pain Management <ul><li>An interdisciplinary approach to making pain manageable, optimizing function and maximizing quality of life. </li></ul><ul><li>Strategies include: </li></ul><ul><ul><li>Drug interventions </li></ul></ul><ul><ul><li>Non drug interventions </li></ul></ul>
  5. 5. Objectives <ul><li>Reduce the incidence and severity of patients’ acute post procedure pain. </li></ul><ul><li>Educate patients about the need to communicate unrelieved pain so they can receive prompt evaluation and effective treatment. </li></ul><ul><li>Enhance patient comfort and satisfaction. </li></ul>
  6. 6. Pain Assessment Scale <ul><li>Scale </li></ul><ul><ul><li>Numeric Rating 0 -10 </li></ul></ul><ul><ul><li>Faces </li></ul></ul><ul><ul><li>Non-English Speaking Patients </li></ul></ul><ul><ul><li>Pediatric Patients </li></ul></ul>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
  7. 7. Assessing Pain <ul><li>Pre-Procedure Phone Call </li></ul><ul><li>Day of Procedure </li></ul><ul><li>Post Procedure Phone Call </li></ul>
  8. 8. Pre-Procedure <ul><li>Phone Call </li></ul><ul><ul><li>3-4 Days Pre-Procedure </li></ul></ul><ul><ul><li>Medical History </li></ul></ul><ul><ul><li>Surgical History </li></ul></ul><ul><ul><li>Current Medications </li></ul></ul><ul><ul><li>Urological History </li></ul></ul><ul><ul><li>Present Symptoms </li></ul></ul><ul><ul><li>Policy C.22.A (Pre-Procedure Call) </li></ul></ul>
  9. 9. Day of Procedure <ul><li>Peri-Operative Nursing Assessment </li></ul><ul><ul><li>Status day of procedure </li></ul></ul><ul><ul><li>Pain Score </li></ul></ul><ul><ul><li>Aldrete Scoring System </li></ul></ul><ul><ul><li>Discharge Instructions </li></ul></ul><ul><li>Anesthesiologist Assessment </li></ul><ul><ul><li>Pain medication if necessary </li></ul></ul><ul><ul><li>Policy C.40.A (Anesthesia General Policy) </li></ul></ul>
  10. 10. Post Procedure <ul><li>Phone Call </li></ul><ul><ul><li>24 – 48 Hours Post Procedure </li></ul></ul><ul><ul><li>Pain Score </li></ul></ul><ul><ul><li>Follow-up </li></ul></ul><ul><ul><li>Patient Survey </li></ul></ul><ul><ul><li>Post ESWL Follow-Up </li></ul></ul><ul><ul><li>Policy C.23.A (Post Procedure Call) </li></ul></ul>
  11. 11. Joint Commission Standards <ul><li>RI.1.2.7 – Patients have the right to appropriate assessment and management of pain. </li></ul><ul><li>PF.2.5 – Pain management as a part of treatment. </li></ul>
  12. 12. Joint Commission Standards <ul><li>P.E.1.4 – Pain is assessed in all patients. </li></ul><ul><li>TX.5.4.6 – The Patient is monitored throughout the post procedure period, with specific attention to pain intensity, quality and responses to treatment. </li></ul>
  13. 13. What to Document? <ul><li>Location </li></ul><ul><li>Quality </li></ul><ul><li>Onset/duration </li></ul><ul><li>Frequency/Intensity </li></ul><ul><li>Present pain management regimen and effectiveness </li></ul>
  14. 14. Patient Education <ul><li>Videos </li></ul><ul><li>Brochure </li></ul><ul><ul><li>Pain Management Techniques For Patients </li></ul></ul><ul><li>Discharge Instructions </li></ul><ul><li>Family or other caregivers </li></ul><ul><li>Policy C. 22. A & C. 23. A Pre and Post Procedure Phone Calls </li></ul><ul><li>Policy C.24.A (Patient Education) </li></ul><ul><li>Policy C.27.A (Lithotripsy Procedure) </li></ul>
  15. 15. Staff Education <ul><li>Orientation </li></ul><ul><li>Inservice </li></ul>
  16. 16. No pain or pain at a tolerable level Reassess No pain or pain at a tolerable level Discharge Procedure (Anesthesia and Analgesia ) Pre-Procedure Patient Assessment Significant pain Drug and nondrug intervention Assess effect of intervention No pain relief Change drug/dose No pain or pain at a tolerable level Discharge – Transfer to Hospital Patient/Family Education Post Procedure Post Procedure Phone Cal l No pain relief