Pain Management FINAL

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Pain Management FINAL

  1. 1. Creating Better PainManagement through ClinicalSimulationHollie AdejumoHoward High School
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Types of Pain Medication Non-Opioid Analgesics Opioid Analgesics
  7. 7. Effective Pain Management http://www.wllc.com/blog/preventing-medication-errors.cfm Combine opioid and non-opioid pharmaceuticals Timely administration
  8. 8. Patient Concerns Psychological Dependence Drug Tolerance Physical Dependence Addiction
  9. 9. 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
  10. 10. Pain Assessment Tools OPQRSTU Pain Scales http://savvypatient.org
  11. 11. OPQRSTU of PainAssessmentO nsetP rovocative/Palliative FactorsQ uality (Open Ended Questions)R egion/RadiationS everityTimingU You “How does pain affect you?”
  12. 12. Pain Scales Numerical Rating Wong-Baker Verbal Rating Observer Scales
  13. 13. Numerical Rating Scale http://understandingpain.wordpress.com/category/pain-assessment-tools/
  14. 14. Wong-Baker Scale http://understandingpain.wordpress.com/category/pain-assessment-tools/
  15. 15. Verbal Rating Scale- McGill PainQuestionnaire http://pain.about.com/od/testingdiagnosis/ig/pain-scales/McGill-Pain-Scale.htm
  16. 16. Observer Pain Scales http://0.tqn.com/d/pain/1/0/V/-/-/-/FLACC.gif
  17. 17. 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
  18. 18. 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
  19. 19. 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/
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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/
  27. 27. 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

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