Harborview Pain Management Orientation Summary
“People will forget what you say and what you did, but people will never forget
how you made them feel.” Maya Angelou
Pain assessment is an ongoing process. Routinely screen for pain. Pain will be assessed at baseline and
at regular intervals after starting the treatment plan, with each new report of pain, at an appropriate
interval following pain relief interventions and more frequently as defined in specific pain management
procedures. One identified (new pain or significant change), minimum assessment = location, severity,
character, goal for pain relief
Use a multimodal approach to pain treatment. The relief of pain includes both drug and non-drug
interventions. Non-drug interventions include physical modalities (heat/cold, repositioning, massage),
cognitive behavioral techniques (relaxation, imagery, distraction, music) and environmental
modifications. Administer analgesics in a timely, logical, and coordinated manner tailored to meet
individual and changing needs.
Engage the patient in realistic goals and the treatment plan. Provide information to the patient and
family when possible regarding the importance of effective pain relief, the pain treatment plan, possible
risks associated with pain treatment, and how to participate in the pain treatment plan including
communicating progress toward the pain management goal. “It is generally not possible or safe to
eliminate all pain, but our goal is to reduce your pain to a reasonable level as well as manage any
unpleasant side effects of pain medicines and help you recover.”
Safety Reminders!!

Always routinely perform safety checks: at times of handover trace lines, be sure lines are
labeled, tubing is appropriate (yellow striped for Epidurals and PNC; tubing vent open if glass bottle
infusing) and pump programming and medication matches current order.
 Perform sedation and respiratory assessment before rousing the patient.
 Reinforce teaching; instruct family and visitors to NOT assist patient with IV PCA.
 Provide extra vigilance with the patient is on other CNS depressants.
 Don’t chase unrealistic numeric pain intensity ratings with opioids. Use a multimodal approach.
0.2mg of IV hydromorphone is approximately equal to 1.3mg of IV morphine
2.0 mg of IV hydromorphone is approximately equal to 13.3 mg of IV morphine or 40mg PO morphine!
Ways to help Improve Patient Satisfaction with pain management
o Individualize patient care to partner with patients
o Use key words “I want to do everything I can to make you as comfortable as
possible. Keeping your pain managed is important. Tell me about your pain right
now”
o Alleviate anxiety (explain rounding)
o Tell the patient when next dose of pain medicine is coming
o Use the whiteboard and encourage communication and address pain at handovers
o Provide complete explanation for new/modified interventions
o Seek alternatives to pain medicine
o Reposition the patient (basic comfort measures)
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IV PCA
Assess/document every 2 hrs for 8 hrs, then Q 4 hrs
• Resp rate and depth (full minute before stimulation)
• Serial sedation levels
• Pain intensity
• Side effects
Total PCA dose is documented every 8 hrs, pump cleared
PCA-by-proxy - instruct family/friends NOT to assist the patient
with IV PCA
A 2-person (RN) independent double check of PCA
settings/medication is required at initiation of PCA therapy and
following any changes (and at start of each shift for peds)
Epidural Analgesia
Assess/document every 2 hrs for 24
hrs, then Q 4 hrs
• Resp rate and depth (full
minute before stimulation)
• Sedation level
• Pain intensity
• Side effects
If Local Anesthetic: Assess/document
BP, HR, sensory level and motor
strength every 30 minutes for 2 hrs,
hourly for 4 hrs, then every 4 hrs
Vasodilation common results in
orthostatic BP
Assess the site/position of the
catheter every shift
May reinforce the dressing around
tegaderm; do NOT replace to avoid dislodgement of catheter
Bolus doses via pump only: except (fentanyl) see policy
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Peripheral Nerve Catheters
Assess/document every 1 hrs for 4 hrs, then Q
4 hrs
(and after an increase in rate or
concentration)
• BP, HR
• Pain intensity
• Neuro-vascular check of affected
extremity: color, temp, sensation, motion
Observe/report signs of systemic local
anesthetic toxicity -Very rare rates <20mL/hr
– ringing in ears, periorbital paresthesia,
nausea
Q/Policies Harborview/Orientation Syllabus Summary Sheet_Pain_Gordon