TIP OF THE WEEK
Fast facts on pain management
Effective Pain Management in Nursing Facilities (PDF), Brown University Center for Gerontology and Health Care Research, 07/24/01
IT IS IMPORTANT TO IDENTIFY BASIC PRINCIPLES THAT CAN GUIDE YOUR PRACTICE:
- For chronic pain, administer medications routinely, not just PRN.
- Use the least invasive route of administration first.
- Begin with a low dose. Titrate carefully until comfort is achieved.
- Reassess and adjust dose frequently to optimize pain relief while monitoring and managing side effects.
CRITICAL POINTS:
- The character (quality) of the pain has been documented on assessment (e.g., burning/shooting pain) so that the healthcare provider can determine the type of pain (e.g., neuropathic pain).
- The oral route is the first choice for analgesics. If a patient is unable to take oral medications, buccal, sublingual, rectal, and transdermal routes are considered before intravenous or subcutaneous routes.
- Patients who report constant moderate to severe pain receive a long-acting medication, and have a short-acting medication ordered PRN for breakthrough pain.
- Patients who report intermittent pain have medications ordered on a PRN basis.
- Only one combination analgesic (opioid and non-opioid, e.g., Vicodin, Tylenol #3) is ordered for PRN breakthrough pain.
- Only one opioid is ordered for continuous moderate to severe pain (e.g., MS Contin, Oramorph SR, Kadian, Oxycontin, or Duragesic.)
- Short-acting oral opioids are ordered at intervals no longer than 4 hours as needed.
- Dose escalations are calculated as a percentage of the current dose, based on the patient's pain rating and tolerance of side effects.
- A rough guideline, assuming normal renal function is pain rated as 3-6 out of 10, dose escalation is 25-50% of current dose; pain rated as 7-10 out of 10, dose escalation is 50-100% of current dose.
- The frequency of dose escalation is dependent on the opioid preparation in use. Doses of oral/rectal/transdermal opioids can be safely escalated (assuming normal renal function).
- Every 1-2 hours -- short-acting oral/rectal products: morphine, oxycodone, hydromorphone.
- Every 24 hours -- long-acting oral opioids MS Contin, Oramorph SR, Oxycontin.
- Every 48-72 hours -- Duragesic Patch, methadone, levorphanol.
- Prescribe adjuvant analgesics for opioid non-responsive neuropathic pain.
- Always have an order for breakthrough pain. Consider using an immediate release opioid at a strength equivalent to 10-20% of the 24-hour dose of the sustained release dose ordered q1-2 hours PRN.
- Never have more than one sustained release preparation at one time.
- An appropriate plan for a bowel regimen is ordered to prevent constipation.
- A plan is in place for a pharmacological and/or a non-pharmacological analgesic intervention prior to activities that are reported to cause or increase pain.
- A pain management flow sheet is initiated on all patients rating pain as moderate (e.g., 5/10, 3/5, or 2/3) on admission.
- Orders for non-pharmacological interventions are present and are clearly stated as part of the analgesic plan.
- The metabolites in Demerol and Darvocet are toxic and long-term use of these drugs is best avoided.
Adapted from the Medical College of Wisconsin, Clinical Resources, Palliative Medicine Program, http://www.mcw.edu/pallmed
Sources
- Acute Pain Management Guideline Panel. Acute Pain Management: Operative or medical procedures and trauma. Clinical Practice Guideline. AHCPR Pub. No. 92-0032. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, Feb. 1992.
- Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain Clinical Practice Guideline No. 9. AHCPR Publication No. 94-0592. Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, March 1994.
RESOURCE SPOTLIGHT
Pain quiz: Are you fooled by familiar pain myths?
Pain can interfere with work, sleep, intimacy and overall happiness. But many people live with untreated pain anyway.
Some don't seek relief because they've bought into the common myths, misperceptions and misunderstandings about pain and pain control. And some healthcare professionals don’t take their patient’s pain seriously for these same reasons. Don't overlook pain in your patients. Learn to separate fact from myth.
IN THE NEWS
January 4, 2007 -- Medline Plus -- What if your mind's eye could take you to a place so peaceful that the experience eased your pain or sped your recovery from surgery? It's not such a far-fetched concept.
"Guided imagery," a type of mind-body therapy that uses visualized images to communicate to the housekeeping systems of the body, is making its way into traditional medical settings.
Read More >>
MEDICAL ASSISTANT IS THE FASTEST GROWING OCCUPATION IN U.S.
January 17, 2007 -- eMediaWire -- The healthcare field continues to represent one of the fastest growing segments of our nation's economy. Employment in healthcare will continue to grow for several reasons -- the number of people in older age groups, with much greater than average healthcare needs, will grow faster than the total population between 2004 and 2014; as a result, the demand for healthcare will increase.
Employment in home healthcare and nursing and residential care should increase rapidly as life expectancies rise, and as aging children are less able to care for their parents and rely more on long-term care facilities. Advances in medical technology will continue to improve the survival rate of severely ill and injured patients, who will then need extensive therapy and care.
Read More >>
OHIO KEPRO EVENTS
QUALITY IMPROVEMENT: TAKING IT TO THE NEXT LEVEL
Objectives:
- Identify the basic principles of quality improvement
- Describe the role of data collection in the quality improvement process
- Discuss ways to improve team performance
- Identify strategies to improve the effectiveness of team leaders and team members
WHO SHOULD ATTEND? Nursing home administrators, directors of nursing, clinical managers, direct care professionals, QI team members
Continuing education credits for nurses and NAB credits for administrators are pending. Please contact Donna Maynard at 1.800.385.5080 to learn the program’s status.
February 8, 2007 through March 8, 2007 from 8:30 a.m. to noon in various locations throughout Ohio.
If you are interested, please download the flyer and register online.
View all Ohio KePRO educational opportunities for nursing homes >>
OTHER INDUSTRY EVENTS
January 30, 2007, 1:00-2:30 ** Please note the change of date
Dial-in: (800) 895-4790
Conference ID: KePRO2
Navigating the MDS Through the Ohio Medicaid Reimbursement System
Ohio Department of Job and Family Services
June 11, 2007 or August 23, 2007
Call Cheryl Robertson at (614) 466-9088 for more information.
Roadmap for Change: 2nd Annual Person Centered Care Coalition Conference
March 20, 2007 – Columbus, Ohio
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>
