Pain Follow-up

[tewdles, RN]

I am investigating pain follow-up practices in hospice and would like some input from my peers...

If you have a patient who reports pain during your visit, would you complete the visit and leave the home before the patient has achieved an acceptable level of comfort? I say no, but I am told that not all hospice nurses practice in this manner, which surprises me.

If you change the POC for pain during your visit, do you make a phone call the next day to assess the effectiveness of the new POC?

If so, how do you document the 24hr pain follow-up? Specifically, is there a particular place within your electronic chart which is specifically for this documentation? It might be helpful to know which software you are using if you are willing to share the vendor name.

Thanks for taking the time to read and answer this, I appreciate your feedback!

[AtlantaRN, RN]

If pain level is 4+ on arrival, and 2 is an acceptable level---we have pt take meds, or add roxanol, until pain level is "2". THEN, a phone call the next day document pain level. usually an increase in pain is because they haven't been using their scheduled pain meds or prn meds are not being used as prescribed.

linda

[AtlantaRN, RN]

we don't use electronic charting............so it's paper documentation

[Hospice Nurse LPN, BSN, RN]

I try to get the pain under control while I'm in the home. One of my pts constantly rates his pain level @ 6, but he's comfortable with that and doesn't want his meds adjusted. For me, 2 is the magic number on the pain scale. Most of the time, it's because PCG isn't giving breakthrough meds as ordered. I , or my DON, calls the family the next day and check on the pt. We don't use electronic charting, but sure wish we did.

[Hospicetex]

We report pain levels above a 3 to our PCC.

I have had situations in which one of my regular patients always has a pain level of a 5 or 6 which is acceptable for him. He refuses 24 hour follow up visits when his pain level is at his acceptable level. However if it is at a non acceptable level we have a protocol of notifying and then changing meds or adding meds to get the patient to an acceptable level of comfort as I am sure you all have for your pain crisis protocol. We also have 24 hour prn visit then a 48 hour phone follow up.

I have had new patients families report that they need medication changed or increased and when I arrive at home I have found patient in pain but scheduled meds were not given as ordered and prn doses not adm. At that point my priority is patient comfort and loads of education regarding pain management.

Do you all promote other comfort measures as well? Deep breathing, use of imagery, soothing music, message? I also teach each of my patients and the families these methods to help promote comfort. I think comfort comes in many ways and want to find the right combination for my patient and the family.

[tewdles, RN]

hospicetex...do you use an electronic chart? do you have as specific pain follow up document within your electronic record? If no, then where do you doc your pain follow up?

yes, alternative methods for pain relief are important...including massage, healing touch, etc.

[Hospicetex]

We are still using paper charting but hope to have computers next year. We have a check off system of charting with narrative on the last page. I usually start on our narrative charting area and proceed to our progress notes as needed. I will also document in the comments part of each area that I address for each body system and try to elaborate on the narrative.

[tewdles, RN]

I remember the days of reviewing paper charts for quality and performance purposes. It is much easier in the digital record...

[Spidey's mom, ADN, BSN, RN]

Paper charting here too.

I stay until the pain is lessened to the patient's comfort level. We have one esophageal cancer patient who is fine with 6 to 7 over 10. He was out weedeating yesterday at this level.

I also do follow up phone calls.

Our hospital is struggling - we've talked about getting laptops and software. But I just don't see it happening.

steph