Palliative Care. And Pain Management

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Blanche Warren
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1 Palliative Care And Pain Management Revised: bw/september 2010

2 Palliative Care Symptom management is a primary goal of palliative care. Pain is one of the most feared symptoms experienced by patients. Effective pain management is critical to healing, quality of life and patient satisfaction.

3 Key Concepts in Pain Management 1. Assessment a) reassess to prevent pain, not prn. 2. A multi-disciplinary approach. 3. Using pain relief methods effectively. 4. Educating patients and their families.

4 Trinitas Pain Management Policy All patients will be assessed for pain upon admission and at least once every 8 hours for inpatients and with each clinic visit for out patients. The clinical staff will work together with the patient to establish a goal for pain relief and develop and implement a plan to achieve that goal. Patients and their families will receive education about pain management to enable them to be active participants in their treatment plan. Pain management will be incorporated into the discharge plan.

5 The Pain Management Team Physicians Nurses Physical therapists Occupational therapists Mental health professionals Social workers Pharmacists Religious or Spiritual leaders The Patient is part of the team, too!

6 What Is Pain? Pain is physical Damage to nerves and tissue due to disease, injury or infection Pain is emotional Stress, anxiety, trauma and depression play a role in a person s suffering No two people are the same Two people with the same injury (or surgery) can experience different levels of pain Some pain has no clear cause

7 Pain Relief Methods Used alone or in combination, include: Medication Cognitive and behavioral techniques (guided imagery, for example) Exercise. Physical agents (massage, heat and cold, etc.)

8 Education of Patients and Families Patients and families must understand: The different types of pain and pain relief options The importance of reporting their pain Why pain relief is important for recovery The effectiveness of pain control measures Barriers to effective pain education and management: Fear of addiction Fear of legal problems Worries about side effects Cultural beliefs

9 Pain Assessment: Many factors play a role in pain assessment for both the person being assessed and the person doing the assessment. These factors include: Culture Age Sex Previous pain experiences Fears and feelings about tolerance, dependency and addiction

10 0 10 Numeric Scale For use with adult patients & children age 7 and older 0 indicating no pain and 10 indicating the worst possible pain Available in different languages Patient must be educated in the use of the tools Tools made available to patient and family for reference

11 The Faces Scale (Wong-Baker) For use with pediatric patients, ages 3-18 Can also be used with adults 0 indicating no pain and 10 indicating the worst possible pain Children must be taught how to use tool

12 FLACC Scale A behavior pain assessment for use in non-verbal patients who are unable to provide reports of pain Ratings are obtained in each measurement category. Scores are added together and a total pain score is obtained from 0-10 For use with adult patients who are cognitively impaired and for children ages 2 months to 7 years

13 FLACC Scale FLACC Scale Scoring Categories Face No particular expression or smile Occasional grimace or frown, withdrawn, disinterested Frequent to constant quivering chin, clenched jaw Legs Normal position or relaxed Uneasy, restless, tense Kicking, or legs drawn up Activity Cry Consolability Lying quietly, normal position, moves easily No cry (awake or asleep) Content, relaxed Squirming, shifting back and forth, tense Moans or whimpers; occasional complaint Reassured by occasional touching, hugging or being talked to, distractable Arched, rigid or jerking Crying steadily, screams or sobs Difficult to console or comfort Each of the 5 categories ( F ) Face; ( L )Legs; ( A )Activity; ( C ) Cry; ( C ) Consolability is scored from 0-2, which results in a total score between zero and ten.

14 Documentation: On Admission, the initial patient assessment will include: Duration Intensity Aggravating/Alleviating Factors Location Character/Quality Effect on ADL s & quality of life

15 Documentation: Daily assessment: Patients will be assessed at the beginning of each shift and as necessary Pain assessment will be located with the other scheduled assessments in the clinical documentation system Medication documentation Upon charting pain medications, document pain scale prior to administering medication Reassess for effectiveness of medication

Pain relief for children

Pain relief for children Inpatient Pain Team Parent/carer Information Leaflet Introduction At The Dudley Group we aim to give your child good pain relief and make them as comfortable as possible after