Pain assessment and management Embedding a Palliative Approach

Pain – assessment and management Embedding a Palliative Approach In Residential Settings (EPAIRS) 1

Steps See – recognize and assess pain Say – report what you see Do – manage the pain (within your scope) Report – your actions Review – reassess: is it working? Adapted from the Residential Aged Care Palliative Approach Toolkit (2012) 2

SEE -What is pain? An unpleasant sensory and emotional experience – Pain is whatever the resident says it is – Residents with cognitive impairment are less likely to get pain medication. • VCH RAI indicators: – 15. 6% of residents have moderate daily pain or severe pain – 11. 2% of residents have worsened pain compared to the last assessment 3

Untreated pain can lead to: • • Delirium Decreased sleep Decreased activity Decreased function Decreased quality of life Social Isolation, Anxiety, Depression Potential for Hyperalgesia 4

PAINAD ▪Unable to communicate (e. g. moderate to severe dementia, language barrier)? 5

NOPPAIN Able to communicate (even with mild dementia)? Ask resident 6

SAY: reporting what you see • Be as specific as you can – When did it start? – Where is the pain? – At rest or with movement? – How often? • Report immediately if it is severe or gets worse 7

DO: managing the pain What are some ways to reduce pain besides medication? – – – Positioning: lying and sitting Massage Heat Relaxation, deep breathing Complementary therapies Distraction (music, movies, visitors) 8

DO: Pharmacological Around the clock dosing is key to good pain control – PRN rule - >3 in 48 hrs. • Non-opioids (e. g. Tylenol, Ibuprofen, ASA) • Opioids (e. g. Dilaudid, Oxycodone, or Fentanyl) – Facts and myths: Tolerance, physical dependence and addiction. 9

Report: share with team members RCA – Report to nurse • What interventions did you try? Have you seen a change in the resident? • Have you talked with family? • Have you noticed any side effects? Nurse – chart note; report to GP • Pain assessment tool used? • Interventions tried? Changes in resident? • Report from RCA, resident, family? 10

Review: reassess • Not just once, but ongoing • Repeat same assessment tool overtime • Continue to share what you see and do with team members. • Remember pain prevention 11