A critical part of patient care, patient perception
As physicians and providers, you play a vital role in the prevention and treatment of pain. We need your helpin ensuring our patients never suffer in pain while at North Suburban. We invite you to remember
that treating pain improves outcomes, decreases length of stay and enhances patient recovery. This is true in
most cases and is especial y wel documented in post-operative pain. Please use the fol owing suggestions
from our Pharmacist and refer to our Pain Management Policy, attached, for guidelines for a comprehensive
approach to meet the needs of patients who experience acute or chronic pain.
Don’t fear abuse. Pain medications used to treat actual pain don’t cause addiction. The perception or
suspicion of a drug seeker can prevent a patient in true pain from getting the treatment they need,
Involve the patient more. Careful assessment and discussion with the patient is critical to success. Some
patients assume physicians don’t like them to take pain medications.
Don’t write orders for multiple pain medications. This is frustrating and confusing for both nurses and
patients. Instead, talk to the patient about their pain and select 1 to 3 pain medications. 3 should be the
theoretical maximum (one for mild, one for moderate and one for severe pain).
It is easier to prevent pain than to treat it. Consider a “baseline” amount of scheduled medication, with
some “breakthrough” agents for PRN usage.
Always treat pain before sedating a patient. This is especial y important in the ICU.
Remember when patients are brought to the floor, they don’t have orders for pain medications until the
admitting physician sees them. When the nurse cal s to tel you the patient has arrived, consider starting
some medications from the “Patient Comfort Orders” Order Set. The order sets are available on 5S,
Remember to tel your patients the reason for prescribing the drug and don’t forgetto go over common side effects. Only 60% of patients feel that they receive good side effect information at NSMC.
Don’t forget about patients’ home medications. Certain pain disorders (e.g., phantom limb pain,
fibromyalgia and other neuropathic pain disorders) don’t respond wel to traditional drugs like opiates or
NSAIDS. Instead, they may respond to drugs like Tricyclic antidepressants, gamma-aminobutyric acid
(GABA) agonists (such as Neurontin). If they were using it at home, they probably need it here if it is safe
Don’t forget about other pain management methods like epidurals, local blocks, pre-operative NSAIDS
and more. These modalities can reduce pain and reduce the need for opiates. Anesthesiologists are a
tremendous resource for these approaches.
Avoid meperidine (non-formulary) and propoxyphene. Both have very little utility and a high likelihood of
adverse reactions. Meperidine has absolutely no place in pain management. Propoxyphene has almost NORTH SUBURBAN MEDICAL CENTER POLICIES AND PROCEDURES POLICIES TITLE: Pain Management REVIEWED: REVISED: 4/02, 1/04, ISSUED: 7/00 2/06, 8/07, 8/10 PERFORMED BY:Caregivers COMMITTEE APPROV COMMITTEE AL: Policy and Procedure SECTION: Interdisciplinary ADMINISTRATIVE ADMINISTRA AL:________________________ FUNCTION: Provision of Care, Treatment TITLE: Vice President Patient Care Services/CNO and Services PURPOSE:
To provide guidelines for a comprehensive approach to meet the needs of patients who experience acute
1. All patients have the right to an accurate assessment and management of their pain.
2. The caregiver assures that patients who experience pain, or are at risk for pain, are reassessed
using the developmental y appropriate and/or patient preferred pain measurement tool and treated
3. Pain that is new or unexpected is reported to the physician immediately and documented in the
4. The patient’s pain management is addressed in the plan of care and reassessed and updated every
5. Patients and/or family members are educated about pain management as appropriate to
developmental age and learning needs.
6. Clinical staff education and competency in pain management is completed during orientation and/or
as required by staff role and/or unit.
7. The patient’s pain management plan is evaluated for effectiveness in planning for discharge.
8. Age appropriate tools are used to assess pain in infants and children. (See nursery specific pain
9. Patients’ concerns regarding pain management are addressed through the Chain of Command.
10. The Occurrence Reporting System is utilized to monitor and document patient concerns. PROCEDURES: Assessment/Reassessment
A. On admission, al patients are asked by the admitting RN:
1. If they experience pain on a regular basis, or if they expect pain as a result of their
2. The intensity, quality, onset, location, causative and al eviating factors in their pain.
4. Which pain measurement scale they prefer to use:
B. Reestablish the patient’s pain goal as necessary.
C. All patients are screened for pain on admission to the hospital. Thereafter, the patient is
2. Whenever an intervention or treatment is provided to relieve pain
3. Whenever the patient’s caregiver changes
4. Whenever the patient’s level or location of care changes (e.g. transfer from ICU to Med/
5. Prior to and during any potential y painful procedures.
D. Pain reassessment is individualized to occur at the time that caregivers expect the intervention
to begin relieving the patient’s pain and discomfort. II. Pain Management
1. Pain is assessed and treated throughout the patient’s course of treatment and stay in our
2. Consider non-pharmacological pain interventions, such as distraction, relaxation techniques,
massage, positioning, and heat/cold for each patient.
3. Ineffective analgesics or treatments are reported to the attending physician and a request is
made for new pain management orders (i.e. medication and/or other treatment modalities). III. Documentation will include:
1. Initial pain assessment on the Admission History within 2 hours of admission
2. Assessment and reassessment in the patient record including the fol owing:
(a) If the patient experiences pain on a regular basis, or if they expect pain as a result of
(b) The intensity, quality, onset, location, causative and al eviating factors in their pain.
(c) Which pain measurement scale they prefer to use:
(d) Pain assessment and reassessment for patients receiving PCA or epidural are
documented on the PCA or epidural flow sheet.
a. When a pain medication is scanned (see list of medications that wil trigger
prompt; Addendum A), the user is prompted to enter pain location, sedation scale,
(a) Response to these queries reflects the patient’s condition prior to administering
b. If eMAR is not utilized in a clinical area, documentation is completed on the
appropriate unit specific documentation.
c. Patient response based on the expected time of medication peak effect and route
d. Any physician notification made for ineffective pain management and/or
e. Patient/family teaching regarding pain management and is documented on the
Interdisciplinary Education Screens.
a. Initial evaluation includes ful pain assessment
b. Reassessment is documented as needed in Daily Treatment Screen and/or
IV. Patient and Family Education
1. The RN provides patients and families (when appropriate)with pain management education
and information on admission to and throughout the hospital stay. Pain management
education and information is also provided by other Healthcare professionals performing
e. Potential side effects of pain medications
g. Complementary and alternative modalities
V. Discharge Planning
1. Discharge instructions detail interventions patients and families can utilize to manage pain
fol owing their hospitalization and treatment.
2. Support services, such as Case Management and Social Services, are utilized to assure
continuity of care beyond the acute care facility.
3. The name and telephone number of the individual to contact with problems, such as
The hospital assess and manages a patient’s pain. Standard PC.01.02.07. JCAHO (2010). 26 Aug. 2010
“Guidelines for pain management.” P&T Digest Dec. 2005.
Pasero, Chris. “Pain Management.” Conf. on Improving Patient Outcomes with Effective Pain Management.
Medications/Classes WITH POP-UP pain assessment SCREEN:
Morphine products (inj & POs including CR tabs-MS Contin)
Oycodone products (including CR tablets-OxyContin)
Opium & Bel adonna (B&O) suppository
Medications/Classes with NO POP-UP pain assessment SCREEN:
General Supply List “Natural Goat Care” by Pat Coleby Kelp Copper Sulfate (use very carefully and in micro amounts) Dolomite (use in conjunction with copper sulfate to prevent overdosing copper) Loose minerals formulated for goats Baking soda (keep in one of the mineral compartments – goats will eat as needed) Collars (unless you have horned goats) Disbudding iron (unless you plan to
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