Parkwest Medical Center
Knoxville, Tennessee
Patient Care / Nursing
Approved By: P&T, 9/04
Approved By:
Approved By:
JCAHO References: RI.2.160; PC.8.10
Scope:
SUBJECT: PAIN MANAGEMENT
POLICY NUMBER: PC.NU.073
PAGE 1 OF 4
Generated By: Pain Management Team
Effective Date: 9/92
Revised Date: 9/96; 5/01; 11/01, 09/04
Review Date: 9/98
Physician, RN, LPN, Pharmacist, Therapists, Technicians, Technologists and Nursing Student with supervision
Purpose:
Provide an interdisciplinary method of pain management through assessment, planning, intervention, evaluation, and patient education. Individuals involved in management of pain may include: physician, nurse, pharmacist, therapists, technicians, technologists, family members.
Policy Statement/Procedure:
The patient has the right to appropriate assessment and management of pain
Pain management may include, but is not limited to, the following:
A.
Patient History – taken at the time of admission
B.
Patient Assessment , which may include:
1.
The patient’s description of the pain.
a) Onset b) Duration c) Location d) Intensity e) Radiation f) Relieved by/worsened by g) Acceptable level
2.
Numerical/Facial Expressions pain scale 0 – 10 (0 = no pain; 10 = unbearable pain), will be used for patients that are able to communicate their pain level.
3.
Non-verbal pain scale will be used for patients that are unable to verbalize or effectively communicate their pain will be assessed by observing for signs of discomfort. Observed signs of discomfort include but are not limited to: a) Emotional (0-smiling, 1-anxious and 2-almost tearful) b) Verbal (0-no pain, 1-moaning, 2-screaming) c) Movement (0-none, 1-restless and 2-immobile) d) Facial cues 0-relaxed, 1-drawn look and 2-frowning) e) Position 0-relaxed body, 1-guarding and 2-fetal position).
4.
Pain/AD will be used for patients that are unable to effectively communicate their pain due to diminished cognitive ability/dementia will be assessed by observing for signs of discomfort.
Observed signs of discomfort include but are not limited to: a) Breathing (0-normal, 1-occ labored short period of hyperventilation, 2-noisy, labored, long period of hyperventilation, Cheyenne stokes) b) Negative vocalization (0- none, 1-occ moan/groan, low level speech with negative quality, 2repeated trouble, calling out, loud moaning and crying.
c) Facial Expressions (0-smiling, 1-sad, frown, frightened, 2-facial grimace)

Parkwest Medical Center
Knoxville, Tennessee
Patient Care / Nursing
SUBJECT: PAIN MANAGEMENT
POLICY NUMBER: PC.NU.073
PAGE 2 OF 4 d) Body Language (0-relaxed, 1-tense, distressed, pacing, fidgeting, 2- rigid, clenching fists, knees pulled up, pulling away, pushing away, striking out) e) Consolability (0-not needed, 1-distracted, reassure/voice, reassure/touch, 2-unconsolible, unable to reassure, distract)
C.
Documentation:
1.
Screening assessment will be done on every admission database.
2.
Documentation of pain score will be done every shift and with each pre and post-intervention in the patient’s medical record.
D.
Interventions:
1.
If pain is rated >3/10 (or equivalent) and/or is unacceptable to the patient, there will be an intervention to reduce pain.
2.
Adverse effects of treatment will be anticipated and monitored
3.
Patients and their families will receive education about their pain relief plans.
4.
Non-pharmacologic interventions will be available and offered when appropriate: a) Repositioning b) Management of environmental stimulus c) Diversionary activities d) Massage
5.
Unless pain is occurring only occasionally, scheduled analgesics are indicated with additional medication available on demand for break-through pain.
6.
Oral and intravenous administration of analgesics is preferred over intramuscular administration.
7.
Opioids are the analgesic of choice for moderate to severe pain.
8.
Demerol is not a first choice for pain management; if used it should not be administered for more than four (4) consecutive days due to accumulation of toxic metabolites.
9.
Non-steroid anti-inflammatory agents are beneficial but must be administered judiciously considering the risk of adverse effects. Toradol (both parental and oral) must not be administered for longer than five (5) consecutive days.
10.
If pain is likely to persist beyond the hospitalization, pain management will be communicated as part of the discharge instructions.
E.
Response / Reassessment:
Reassessment of pain is essential to effective pain management.
1.
Reassessment of pain will occur: a) As a component of the overall shift assessment b) With each new report of pain c) After administration of pain medication i.
Reassess patient for effectiveness of pain medication in a time frame appropriate for drug, dose and route of administration d) At appropriate intervals after each pharmacological or non-pharmacological intervention
2.
Accept and act on patient’s report of pain.

Parkwest Medical Center
Knoxville, Tennessee
Patient Care / Nursing
SUBJECT: PAIN MANAGEMENT
POLICY NUMBER: PC.NU.073
PAGE 3 OF 4
3.
Documentation of reassessment of pain will indicate if pain is: a) Improved b) Tolerated c) Not tolerated d) Unchanged e) Worse
4.
If pain is rated > 4 and/or is unacceptable to the patient and interventions have not been effective, the nurse will notify the physician.
5.
Documentation of physician’s response will indicate: a) Order received b) No order received c) No response from physician
6.
Patients are also encouraged to discuss the plan for pain management with their physician.
7.
Physicians will be responsible for modifying orders for pain management.
F.
Patient Education:
1.
Document patient education concerning pain management on the patient’s education record.
2.
Instruct patient and family on use of the pain rating scale.
3.
Instruct patient/family on measures to control pain.
4.
Inform patient/family how pain management is part of the treatment plan.
5.
Provide patient/family with pain management educational material.
G.
Discharge Planning:
1.
Address patient needs for symptom management in the discharge planning process.
2.
Pain management at home is addressed and documented in discharge instructions.
H.
Staff Education: The healthcare team will be knowledgeable of:
1.
Types of pain
2.
Recognition of pain
3.
Assessment of pain
4.
Interventions for control of pain
5.
Documentation of pain
6.
Barriers and misconceptions of pain management
7.
Patient education
Reference:
Acute Pain Management in Adults: Operative Procedures. US Dept of Health and Human Services, Public Health
Service Agency for Health Care Policy and Research. AHCPR Publication No. 92-0019. Feb 1992.
Management of Cancer Pain: Adults. US Dept of Health and Human Services, Public Health Service Agency for
Health Care Policy and Research. AHCPR Publication No. 94-0593. March 1994.
Pain: Clinical Manual. McCaffery, M; Pasero, C. 1999, Mosby, Inc.
.

Parkwest Medical Center
Knoxville, Tennessee
Patient Care / Nursing
SUBJECT: PAIN MANAGEMENT
POLICY NUMBER: PC.NU.073
PAGE 4 OF 4
PA IN INTENSITY SCALE
0 1 2 3 4 5 6 7 8 9 1 0
Non-Verbal Observed Pain Assessment Tool
1.
Emotional = 0-smiling, 1-anxious, 2-almost tearful
2.
Verbal = 0-none, 1-moaning, 2-screaming
3.
Movement = 0-none, 1-restless, 2-immobile
4.
Facial Cues = 0-relaxed, 1-drawn look, 2-frowning
5.
Position = 0-relaxed, 1-guarding, 2-fetal position
Diminished Cognitive ability
1.
Breathing = 0-normal, 1-occ labored, short period of hyperventilation, 2-noisy, labored, long period hyperventilation, Cheyenne Stokes
2.
Negative Vocalization = 0-none, 1-occ moan/groan, low level speech with negative quality,
2-Repeated troubled, calling out, loud moaning, crying
3.
Facial Expressions = 0-smiling, inexpressive, 1-sad, frown, frightened, 2-facial grimace
4.
Body Language = 0-relaxed, 1-tense, distressed, pacing, fidgeting, 2-rigid, clenching fists, knees pulled up, pulling away, pushing away, striking out
5.
Consolability = 0-not needed, 1-distracted, reassure/voice, reassure/touch, 2-unconsoable, unable to reassure, distract