Assessing for Pain on a M/S Floor: How Often?

  1. How often are you supposed to (as directed by your NM) assess for pain on your floor?
    We are supposed to ask the patient if they are in pain every time we go into the patient's room...!
    So if you go into the patient's room 5 or 6 times in an hour, you would be asking them the same question five or six times.
    I certainly understand the need to keep on top of pain but what is the RATIONALE or LACK thereof for such frequent assessments and disregarding everything else?

    Why would you assess for pain ten minutes after giving IV pain med? Also, why should we assess for pain, not giving the same weight to other things (knowledge defecits regarding things like self-administering insulin or something like that).
    Honestly I wonder if the hospital isn't catering to drug-seekers since we get SO MANY of them thru the ER and they all seem to come to our unit.

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  2. 10 Comments

  3. by   Daytonite
    I understand your frustration about inquiring as to a patient's pain level 5 or 6 times in an hour. That is a bit too much. But, so is going in and out of a patient's room 5 or 6 times an hour. Why are you having to go in and out of your patient's room that often in an hour? Just asking. Just a guess, but perhaps the NM doesn't think the patient's pain levels are assessed enough in order for them to be comfortable. Maybe she's had some complaints.

    It's perfectly valid and correct to assess for pain 10 minutes after giving IV pain med. At the least the poor schmuck should be checked to make sure he isn't having an anaphylactic reaction and coding.

    You should assess for pain because sometimes the patient won't tell you, or doesn't possess the mentality to introduce the subject due to some disease process going on. A good nurse anticipates her patient's needs and confirms or negates them by asking questions. That's nursing process.

    Way too negative an attitude being expressed here. Hope you can find it within yourself to look at things from a more positive point of view.
  4. by   redwinggirlie
    Nicely put.
  5. by   AlexCCRN
    Assessing pain can also be accomplished without asking the patient - VS, nonverbals, trends, etc.. I've experienced that asking too often seems to train or encourage a yes or exagerated response when their level is actually tolerable. Ater admin, I follow up in an hour, giving the med a full opportunity to work. Then I follow up when the med is anticipated to have begun wearing off, try to intervene before pain is out of control - much easier to manage with lower doses. I don't encourage narcotics but if prescribed I certainly never withhold. I often wonder what's behind the prejudice in pain medication delivery?
  6. by   Town & Country
    I understand your frustration about inquiring as to a patient's pain level 5 or 6 times in an hour. That is a bit too much. But, so is going in and out of a patient's room 5 or 6 times an hour. Why are you having to go in and out of your patient's room that often in an hour? Just asking.
    I'm not going in and out of the room that often....note: I said IF.

    It's perfectly valid and correct to assess for pain 10 minutes after giving IV pain med. At the least the poor schmuck should be checked to make sure he isn't having an anaphylactic reaction and coding.
    Yes I am aware that "the poor schmuck" should be checked to make sure he/she isn't having an adverse reaction.....that's obvious....I'm talking about when you have been giving the same pain med to said patient...I'm talking about throughout the shift, thought that was pretty apparent in the scenario I described as in going in and out of the room...
    You should assess for pain because sometimes the patient won't tell you, or doesn't possess the mentality to introduce the subject due to some disease process going on. A good nurse anticipates her patient's needs and confirms or negates them by asking questions. That's nursing process.
    I'm not talking about a patient who won't tell you that they are in pain....obviously.
    I'm talking about the nursing care of drug-seeking patients that even the docs tell you have no real need to be in the hospital.....I'm not talking about a patient who doesn't possess the mentality to express themselves due to a disease process.....
    ...please, refrain from the personal digs.

    Anyone else want to address the question I posted?

    Thanks.
  7. by   Town & Country
    Assessing pain can also be accomplished without asking the patient - VS, nonverbals, trends, etc.. I've experienced that asking too often seems to train or encourage a yes or exagerated response when their level is actually tolerable. Ater admin, I follow up in an hour, giving the med a full opportunity to work. Then I follow up when the med is anticipated to have begun wearing off, try to intervene before pain is out of control - much easier to manage with lower doses. I don't encourage narcotics but if prescribed I certainly never withhold. I often wonder what's behind the prejudice in pain medication delivery?
    Yes, but the NM specifically said we are supposed to ask. That's what has me stumped, because several nurses at work have been discussing this issue....how that when certain drug-seeking patients often claim they have pain of ten on a scale 1 - 10, never goes any lower even after admin of an IV narcotic or their dozing or other very obvious non-verbal clues that they are not in agonizing pain......
    There may have been complaints I don't know, I wouldn't doubt it because we get lots of drug-seekers.
    Just wondering why the focus on pain to the exclusion of everything else in the ongoing assessment....
  8. by   perfectbluebuildings
    At our hospital, we have a policy of assessing w/in 30 min. post IV pain med, or w/in 1 hr post oral pain med, for relief/effect. We assess pain in our initial assessments, and then if the pt has an issue, we do some kind of intervention and keep on assessing for effectiveness. Kind of like with someone in GI distress etc. ... we will keep on assessing and intervening till there's improvement/resolution. Of course, I am in peds so the drug seeking thing is a very rare prob, except when kids get prescribed demerol IV long term and start having issues... but that's different than what you describe, and is a change from behavior at admission, you know what I mean? it's something that is partially caused by how their pain was treated initially within the hospital, not outside behaviors. I don't know how frequent that could be in older pts as well- how often they are prescribed meds that may be physically addicting. We go a lot on nonverbal s/s as well. I have found more kids unwilling to express that they're in pain, when they are showing all kinds of nonvbl signs, than kids asking for more and more pain meds when they seem not to be in pain. But those few experiences are a LOT more frustrating than the majority of "stoic" kids, who can usually be educated and persuaded to take some meds if they are obviously needed.
  9. by   Daytonite
    you did ask "why would you assess for pain ten minutes after giving iv pain med?" i responded. i read the post over several times as i thought it was a nursing student or new grad who had posted it. giving the same pain med to said patient throughout the shift was not clearly stated in the original post. and, no, it wasn't obvious that you were not talking about a patient who won't tell you that they are in pain. i am not psychic. i do not have a crystal ball. if i've learned anything as a nurse, it is not to assume anything. i was not making personal digs and i'm sorry you interpreted my post that way. i was merely trying to be helpful and respond to the information given.
  10. by   luvmy2angels
    Quote from SunStreak
    I'm talking about when you have been giving the same pain med to said patient...I'm talking about throughout the shift,
    You are aware then, that an allergic reaction can happen at ANY time, even if you have taken the same drug for 20 years.....It can still happen. Just because they have been taking it all shift doesn't mean that the last time you give it they aren't going to have any kind of reaction. It is also important to check 10 minutes after giving an IM med to see if it is effective. Most IMs are effective within 10-15 minutes, some even sooner.
  11. by   Town & Country
    At our hospital, we have a policy of assessing w/in 30 min. post IV pain med, or w/in 1 hr post oral pain med, for relief/effect. We assess pain in our initial assessments, and then if the pt has an issue, we do some kind of intervention and keep on assessing for effectiveness. Kind of like with someone in GI distress etc. ... we will keep on assessing and intervening till there's improvement/resolution.
    That's my rule of thumb.
    I check back to see if the pain med was effective, if they are relieved, etc, or if they need anything else like repositioning, etc...
    Just don't understand management's rationale for asking every time you are in the room, seeing as how we have so MANY drug seeking patients.
    It's almost like they are playing to that drug-seeking behavior IMO.
  12. by   stn2003
    Hospital policy in my area (cardiac/,med-surg) states that pain MUST be assessed at least once a shift and then prn as necessary depending on the pain level, interventions, and of course evaluation of interventions. On patients with a PCA, the pain level gets assessed more often.

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