Pain Management

[txdon]

I am beside myself. I have multiple residents who c/o pain constantly. When asked what their pain level is, they reply 8-9. When I ask the nurse what is being done for their pain the reply is always, "He/She isn't due for anything yet or I just gave them something." I am having an issue if one nurse in particular. When I tell him the resident is reporting pain 9 out of 10, he gets very upset and feels he's being attacked. He automatically goes in defense mode and relies, " I know. She isn't due for anything yet." Ofcourse I press on and question what other interventions could be done and he tends to argue and says I will go talk to her." He then goes into the resident's room and says,"You can't get anything for another hour." Then he leaves the room. This isn't okay. Nurses often justify not giving meds due to the resident not exhibiting visual signs of pain. Any advice on how to handle this nurse? He is viewed as a bully and has been allowed to get away with things such as this for years.

[CoffeeRTC, BSN, RN]

Wow...total need for a pain management inservice. Could you have a pharmacist or someone from a hospice come in and do this or maybe just even you or your staff development. Critical thinking is totally lacking.

[CapeCodMermaid, RN]

Bullying is never okay and neither is ignoring someone's pain. There are many non-chemical ways to relieve pain and the DPH looks to see if they are being used. Maybe an assist with repositioning to get more comfortable. How about an activity to take their mind off of the pain. Here's a thought: since most docs tend to be stingy with pain meds in LTC, take a look at what the resident has ordered. One vicodin or percocet every 8 hours will NOT manage post op pain. If the pain is chronic, how about a scheduled dose of something or a patch. I worked with a woman who said demented residents didn't feel pain like we do and would never advocate for pain medicine for them. One resident winced every time she took a step. This nurse tried to tell me it was just a facial tic. I went behind her back and asked the charge nurse to give the woman 650 of tylenol before breakfast and again before afternoon activities. The 'facial tic' miraculously disappeared. I work with drug addicted residents and some times it is hard to quantify their pain, but for the most part, people in LTC are under-medicated and we need to advocate for them.

Call your local hospice. Ours has a fantastic program on pain control. Or call a local pain clinic to see if they will come in and inservice.

[noc4senuf]

In 2008, our group collaborative received a PIP grant from the State of MN , the subject was Pain. Our whole P&P and program is lissted now for the public.

carechoicemn.org then go to PIPP Best Practices, then Pain. Hope this helps.

[achot chavi]

Bzyodon,

I totally understand you and can assure you that the problem is real and not just by you.

This happens everywhere and when it happens on my watch, I try to role model to the nurse what I expect from her or him. Whether it is interviewing the patient and coming to the source of the pain- sometimes a simple shift in the wheelchair or a pillow in the right place makes all the difference. Sometimes it is finding a volunteer to take the patient for a walk (SW can help with that), sometimes it is asking the doctor for a change in medication, or the physical therapist to see what she can do etc.

Instead of chiding, I like to role model what I expect of my nurses and it really helps.

I liked some of the other ideas presented above as well. You can make an inservice really effective by following up with QA checks.

[CompleteUnknown]

You know, if you have 'multiple residents who complain of pain constantly' it sounds as though you may have a big problem with the way pain is managed in the facility. I think some pain management inservices would be a great idea, as another poster mentioned.

Another thing to think about is trying to avoid PRNs as much as you can and instead see if you can get people onto scheduled pain medication. With the best will in the world, it's very difficult to manage chronic pain with PRNs and most residents will do much better with regular doses. If they already are on regular doses and are still in pain, they need to be reviewed (as you know). If the nurses aren't looking at this/don't know they can/don't know they should be/don't have time/whatever, maybe you'll have to do it yourself, at least to start with. That's along with the sixteen million other things you have to do of course.

Are any of the nurses particularly interested in pain management? Maybe you could think about sending someone to a seminar or course and then getting them to help you sort this out?