Interdisciplinary Management of Pain Greater Baltimore Medical Center

Definitions • Acute Pain: generally time-limited, and is responsive to opioid and non-opioid therapy • Chronic Pain: exists beyond its expected time frame for healing or where healing may not have occurred; It is persistent pain that is not amenable to routine pain control methods

Pain Policy at GBMC • All patients treated at GBMC will receive appropriate analgesic care • All patients treated at GBMC will be assessed for the presence of pain, in both inpatient and outpatient areas

Assessing Pain • Patient’s self report will be the standard used in assessment • Assessment begins on admission for pain and acceptable level of pain while hospitalized • Pain is to be assessed/reassessed at the following intervals: − − − After any known pain producing event With each new report of pain Following therapeutic intervention In accordance with the algorithms for acute and chronic pain With the daily assessment (q 8 h) if pain is not present on admission

Other Considerations • All patients will be assessed q 8 h for any associated symptoms of pain control therapy − nausea, itching, constipation, over-sedation, and inability to void • Placebo use for pain control is not allowed • Patients and family should be educated on the right to pain management, interventions to relieve pain, and their role in managing pain

Pain Consultative Services • Department of Anesthesia will consult for: − Acute Epidural Analgesia − PCA pumps • Department of pediatrics will consult on any patient under 16 years of age

Pain Education • Patient education tools will be made available to all patients upon admission − “What Patients and Families need to know about Pain Management” (Form # 34680) − “What Parents need to know about Pain Management” (Form # 34681) • Nurse is responsible for assessing educational needs and developing and educational plan based on: − − − Plan of care Patient goals Culture Age Developmental Stage

Pain Screening Tools • Visual Analogue Scales are used to screen patients • For patients unable to self report, behavioral scales are used • Non-English speaking patients are screened using language specific pain tools, an interpreter, or the assistance of the AT&T Language Line • Pain Scales used at GBMC − − Numbers scale (0 -10) for adults Faces scale for children 3 years and older FLACC Scale for 3 months – 3 years NPASS Scale for neonates

Pain Documentation • Pain Assessment/Reassessment is documented in Meditech PCS − Admission Database − Pain Assessment/Reassessment Intervention • Includes the following information: − − − − Intensity of Pain Description of Pain Location of Pain Aggravating / Alleviating Factors Associated Signs / Symptoms Impact on Functional Ability Methods of pain management that have been useful in the past Patient’s personal goal for pain management

Pain Documentation • Pain Reassessment is documented in Meditech PCS − Pain Assessment/Reassessment Intervention • Reassessment occurs on the following recommended intervals: − Oral Medications: within 60 -90 minutes after dose administered − Intramuscular/Subcutaneous Medications: within 60 -90 minutes after dose administered − Intravenous Medications: within 30 -60 minutes after dose administered • Any pain medications administered are documented on the MAR in Meditech

Patient Controlled Analgesia (PCA) Pumps • The CADD Prizm Pain Control System is used to deliver continuous (basal rate) dosing and/or patient administered (bolus)doses. • Two RNs are required to independently double check orders and pump settings at each order change, change of shift, prior to transfer of patients between units, and when receiving a patient upon arrival to the unit • PCA cassettes are supplied by pharmacy (found in Acu. Dose, delivered by the pharmacy to unit, or picked up by the nurse at Pharmacy if not premixed) • PCA pumps are obtained from Central Sterile Supply • All PCA documentation is entered into Meditech PCS in one of the following interventions, as appropriate: − IV PCA Flowsheet (for Morphine and Dilaudid use) − Epidural PCA Flowsheet (for Epidural PCAs) − IV Fentanyl PCA Flowsheet (for Fentanyl use only)

More Information • Please review the pain tools document found on the www. gbmc. org site – listed with the Pain Self Learning Packet and test • Please take the Pain SLP Test and submit certificate of completion to agency