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Posted by KarenT ( on August 20, 2001 at 15:13:55:

In Reply to: not really I cant get the link into the post, its posted by don on August 20, 2001 at 15:04:00:

that your nurse/doctor ahould be doing too. Are they? If not and they aren't treating the pain properly,it is reportable to not only your state board of health but also JCAHO. No hospital in their right mind wants to take a chance on losing their accreditation. Right,Don?

Assessment of Patients Functional Chapter

Pain is assessed in all patients.

Intent of PE.1.4
In the initial assessment, the organization identifies patients with pain. When pain is identified, the patient can be treated within the organization or referred for treatment. The scope of treatment is based on the care setting and services provided. A more comprehensive assessment is performed when warranted by the patient's condition. This assessment and a measure of pain intensity and quality (eg, pain character, frequency, location, and duration), appropriate to the patient's age, are recorded in a way that facilitates regular reassessment and follow-up according to criteria developed by the organization.

Examples of Implementation for PE.1.4

All patients at admission are asked the following screening or general question about the presence of pain: Do you have pain now? Have you had pain in the last several months? If the patient responds "yes" to either question, additional assessment data are obtained:

pain intensity (use a pain intensity rating scale appropriate for the patient population; pain intensity is obtained for pain at present, at worst, and at best or least; if at all possible, the pain rating scale is consistently used in the organization and between disciplines)

location (ask the patient to mark on a diagram or point to the site of pain)

quality, patterns of radiation, if any, character (elicit and record the patient's own words whenever possible)

onset, duration, variations and patterns

alleviating and aggravating factors

present pain management regimen and effectiveness

pain management history (including a medication history, presence of common barriers to reporting pain and using analgesics, past interventions and response, manner of expressing pain)

effects of pain (impact on daily life, function, sleep, appetite, relationships with others, emotions, concentration, etc.)

the patient/client's pain goal (including pain intensity and goals related to function, activities, quality of life)

physical exam/observation of the site of pain

Patient/clients often have more than one site of pain. An assessment system or tools with space to record data on each site is provided on the assessment sheet.

A hospital may need to use more than one pain intensity measure, depending on their patient/client population. For example, a hospital serving both children and adults selects a scale to be used with each of those patient populations. Assessment of cognitively impaired patients may also require assessment of behavioral factors signaling pain or discomfort.

Staff are educated about pain assessment and treatment including the barriers to reporting pain and using analgesics. Staff encourage the reporting of pain when a patient/client and/or family member demonstrates reluctance to discuss pain, denies pain when pain is likely to be present (for example, post-operative, trauma, burns, cardiac emergencies), or does not follow through with prescribed treatments.

Pain intensity scales are enlarged and displayed in all areas where assessments are conducted. For organizations using clinical pathways, pain assessment is incorporated in some way, into every appropriate clinical pathway.

An organization selects pain intensity measures to insure consistency across departments; for example, the 0-10 scale, Wong Baker FACES Pain Rating Scale (smile-frown), and the Verbal descriptor scale. Adult patients/clients are encouraged to use the 0-10 scale. If they cannot understand or are unwilling to use it, the smile-frown or the verbal scale is used.

A unit caring for persons with Alzheimer's disease developed a pain scale for each resident based on their long-standing knowledge of their residents and their knowledge of the common pain syndromes in elderly persons.

A pediatric hospital includes, in its introductory information for parents, information about pain and pain assessment, including parents' role in interpreting behavioral changes of their child that may indicate pain or discomfort.

But,hey,what do I know? LOL


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