Every visit, pain is 7?

A few thoughts/questions come to mind:

--Does she have a belief that pain is required to atone for sins before dying?

--Why don't family members give her the pain medications when she cries all weekend because she's been in severe pain?

--Is she getting some secondary gain by having pain or by rating it a 7 whenever hospice staff is present? Is she getting attention she doesn't get otherwise?

--Why does the CM have to stay after the patient is medicated, until pain is less than 4? Can't the CM go on with her work and the pt. could call the agency if the med isn't working enough? Or family could?

--You can educate until you're blue in the face but you can't force people to do what would help them. Just document, document, document.

Personally, I'm thinking spiritual or emotional pain. However, pt is refusing MSW and chaplain visits. Will she visit w/ her own minister? Have you thought about antidepressants?

I had a pt like this once....very draining emotionally for me. Pt did not stay on service long as family decided to seek agressive tx.

yep, these patients can be difficult and time consuming.

You are doing all the right things. Make sure you document her pain, a good pain assessment, her level of acceptable pain, and her preferences for controlling her pain.

Is she on a long acting opiate? Would she be a candidate for an infusion to control her discomfort. As you know, the type of pain will help you to determine what her options might be. In a case such as this, where the patient/family is not compliant with prn meds but the pt reports unacceptable pain levels, I like to increase long acting meds or switch to infusions. The goal is to get the pt comfortable, not to get her compliant with the POC.

Good luck!

What kind of pain is she complaining about? mets to bone? My organization uses a ketamine gel that works great for that.

And as above, document your education, especially to family.

Good luck, don't let the energy vampires get you down.

What kind of pain is she complaining about? mets to bone? My organization uses a ketamine gel that works great for that.

I've never used ketamine. What kind of dosage and what is it compounded with? thanks!

I agree a long acting opiate like mscontin or a cadd pump. What is her dx?

Is she on a long acting opiate? Would she be a candidate for an infusion to control her discomfort. As you know, the type of pain will help you to determine what her options might be. In a case such as this, where the patient/family is not compliant with prn meds but the pt reports unacceptable pain levels, I like to increase long acting meds or switch to infusions. The goal is to get the pt comfortable, not to get her compliant with the POC.

Good luck!

after working hospice many years, please consider the following:

when you ask a pt their pain level, they often are responding to their mental and physical pain.

it's their way of saying that even if the physical pain has improved, the 'other' pain is just too much.

that is why you often get unchanging numbers on the pain scale.

not always, but certainly worth noting.

leslie