Pain control-Nursing intervention or pharmacy intervention

[at your cervix]

Sorry if this is a little long.

Our department recently had problems with nurses that were giving medication that was often too strong for pt's pain level. For example, first time mom with intact perineum was getting two percocet every three hours and no other meds had been tried. The doctors were concerned that patients were requesting to go home with percocet. They decided to add a pain scale on their orders so for example, pain rated 1-2 on 0-10 scale is motrin, 3-4 is tylenol 3, 4-7 lortab, 7 or higher percocet (or something similar). It seems to be working well. But now all of a sudden, the pharmacy has decided to start auditing the nurses charting to make sure that they are following this. My personal feelings on this subject are that this is not a pharmacy action and that auditing the chart gives them access to other information as well that they do not need to have access to. I also feel that pain control is a nursing action and if I have a patient that rates her pain 2 but is crying and unable to get out of bed, I am going to go with a stronger medication. On the other hand if I have a patient jumping out of bed and walking around, talking and laughing with family that rates her pain 9, I may choose a less strong pain med. What do you think????

[DelightRN]

I think you're absolutely correct. There is a lot more to assessing a patient's pain than accepting a number on a scale, particularly when there are numerous studies that suggest people do not always self report accurately.

Furthermore, if the orders with pain scales were created by physicians, I don't see where the pharmacy has anything to do with that. If an auditing process is indicated, it should be a peer or NM audit, not one by another department. We have several audits that are ongoing, and pain control and assessment of effectiveness is one of them.

[SmilingBluEyes]

Answer: MULTIDISCIPLINARY/multifaceted issue.

involving, patient, nurse, pharmacy, health care provider/dr, and even possibly social worker/psych.