Pain Assessment (acute)

RNKPCE · Nov 5, 2003

We use the pain scale 0-10. O is no pain and 10 is the worse pain you can imagine. Not everyone can use the scale. Also you can use things such as facial grimace or smiling to help with pain assessment. We are told to keep pain at a 4 or less. Some patient might rate their pain as a 7 but refuse any pain med we document that as well.

To get the ball rolling for actual documentation we often uses incentives. Chart audits are done over a period of time and the shift with the best percentage of pain documentation gets pizza one night at work. It sounds juvenile but it has worked many times for other new things introduced on a unit, or for things that are old but just not done right.

In California it is the 5th vital sign and is required by law. The paper where we chart the other vitals has a column for pain level on it, it is easy to see if it is done or not. Also required is the response to any intervention that was done to decrease the pain.

LydiaGreen · Nov 7, 2003

Pain assessment is a must in my clinical placements as a student. And client teaching about pain assessment is also a must. We do not just dole out pain meds, we try to teach the clients other techniques for coping with pain, (heat, therapeutic touch, distractions such as music, reading, tv, walking if possible, etc, etc). We teach the patient to assess their own pain... this allows the client to take more control over their hospitalization and their recuperation or the dying process. For most clients, they feel that discomfort becomes pain at a level of 4 or 5. We also teach them that waiting until the pain is an 8 or a 10 means that will take longer to get it under control again. When it reaches that point of transition for them (from discomfort to pain), we teach them that it is better to take pain meds then, then to wait until they are on the ceiling.

I don't think that there can be one policy that works for everyone with regards to pain control. The client teaching that we TRY to provide is geared towards not creating addiction but ensuring that the client is not in pain.

angelbear · Nov 7, 2003

First of all I dont think the 0-10 scale tells us much. What is a 2 to me maybe a 6 to someone else. Take my mother for instance. She has had several strokes and a pretty severe fall several months ago. She broke her shoulder and her spine and she badly dislocated her knee to the point of requiring quite extensive surgery. She is also IDDM and has post polio syndrome. Whenever she was asked about her pain she would reply with no I dont. But then when one of us girls would ask her why she was grimmacing and grouchy she would say her knee felt tight and was driving her nuts. Obviously she was in pain and needed medication but her description was not of pain but extreme discomfort. When we asked her why she did not want any pain meds she said she was tired of shots. She did not understand that she could have it po. I myself am a nurse who happens to suffer with fibromyalgia etc.. I am used to being in mild to moderate pain I also know that nurses are some of the most judgemental people I have ever met and I do not want to be considered a drug seeker. I also think the assessment should be more detailed like for example ask the pt for an example of what a 1 is to them a 5 and then a 10. For me a 1 is an annoying hang nail or paper cut, a 5 is a HA headed for a migraine or a sprain, a 10 is labor or a spinal or encephalitis HA. With a 4 I would want tylenol or ibuprofen and maybe a heat pad or cool cloth for my head, with a 5 I know I am headed for trouble so I would want something stronger. If I get to a 7 I am going to be torked. I dont know if this is the type of help you were looking for but that's what I have. Sorry so long I am very close to this subject. I should get into some sort of pain research or something. For me an alternative to drugs for like say a migraine is for my husband to put his hand on my head and apply firm pressure with soft soothing music in the background believe it or not this actually works about 40% of the time. I dont mean to be on a soap box and I hope I have in some way maybe helped.

christinemj · Nov 7, 2003

This is how pain is assessed at a hospital at which I recently did a clinical. The 0-10 scale is generally used, and, on admission, a patient is asked what their "acceptable" pain level is. This sets a baseline to identify each person's particular pain "tolerance." In general, most pt's give an acceptable pain level of 3 and start to request pain meds at 5ish. However, this particular tool is helpful for those pt's with a high pain tolerance who rate their pain at 8 but still don't want meds.....or those pt's that listed an acceptable pain level of 0 and REALLY mean it!

It is also helpful when someone lists their acceptable level at 3, for example, and when they report their pain to be at a level 5, the nurse also knows that it is time to start actively OFFERING the PRN meds, before the pain gets out of hand.

Katnip, RN · Nov 7, 2003

We are required to ask the patient about pain levels. We use the 0-10 scale. After we give a med we're required to follow up within 15-minutes to an hour depending on the med given and route, to reassess the pain and if the patient is satisfied. Woe to the nurse who does not chart this on a pain flow sheet in the MAR.

June55Baby · Nov 7, 2003

Cyberkat...

you say "woe to the nurse" who doesn't document reassessment of pain.... What happens? Verbal counseling? Does it work?

We have a problem with reassessment at our hospital, but counseling doesn't seem to work.

Rhonda

sanakruz, ADN · Nov 7, 2003

Batmik is right about CA- Even in Psych we ask about pain, it can cause serious depression if chronic.

Angelbears point is valid. Not everyone will be properly assessed by the 1-10 scale. Different populations need different tools. Children and older people (or those with whom you might have a language barrier) seem to be able to grasp what's being asked if a board with smiley/crying faces is held up and they are asked to point at which one they "are"

Cultural stuff comes into play also. My Russian relatives seem to have a high tolerance because they believe some things are "supposed" to hurt, so one should just bear it. To me this is ridiculous. (Having a baby? What do you expect? Broken leg? No kidding! its broken, right? Cancer tsk tsk, well pray for you.) They will not take pain meds unless-"The Doctor said you have to."

I believe alot of cultures are like this.Challenging isnt it?

:rolleyes:

Katnip, RN · Nov 7, 2003

Well, as far as woe to the nurse, first we get nagged a few times. If the problem continues, we get nagged, then are written up. Then the nurse manager starts nagging. If it continues then we're required to take a competency course with our pain management team. If a nurse still hasn't caught on, it could mean termination.

A lot of this is because JCHAO will be sprining surprise visits any time beginning in January, and pain management is a huge issue with them. If they see there is consistently no follow up, JCHAO will start citing the facility.

And what's said above is also true. The numeric scale doesn't always work for pediatrics, people with dementia, and varying states of conciousness. We have different scales for many of those.

Cultural differences are a whole different set of problems. I'mnot sure how to get through to people about that. Some are so stoic through the worst kind of pain, others practicaly want morphine for a fingerstick.

June55Baby · Nov 10, 2003

Thanks, cyberkat. Right now all our errant nurses get is a nagging from the NM, but I like the idea of a competency course with the Pain Management Team!