Pain Management

1. PURPOSE:

 1.1 To provide effective pain management, nursing assessment, physical examination.
 1.2 To maintain an interdisciplinary team approach to pain management that provides the resident with optimal
   comfort, dignity and quality of life.
 1.3 Communication and assessment methods for residents who are unable to communicate their pain or
  who are cognitively impaired
 1.4 Strategies to manage pain including non-pharmacologic interventions, equipment, supplies, devices
  and assistive aids, and comfort care measures.
 1.5 Monitoring of patient’s responses to and the effectiveness of the pain management strategies.

2. POLICY:

 2.1 All IHHC nurses must assess the patient within 1 hour after receiving oral medication for relief or effect
  of medication and within 30 minutes if the patient receives IM or IV pain medication.
 2.2 All IHHC nurses must assess the patient at least once per shift and then PRN as necessary depending on
  the pain level, intervention and evaluation of intervention.(Appendix A: Nursing pain assessment and
  reassessment)
 2.3 Patient experiencing pain must be treated using non-pharmacological and pharmacological methods to
  optimally control pain, maximize function and promote quality of life.

3. DEFINITION:

 3.1 Pain: An unpleasant subjective experience that can be communicated to others through self-report when
  possible and/or a set of pain-related behaviors. It is an unpleasant sensory and emotional experience
  associated with actual or potential tissue damage, or described in terms of such damage.
 3.1.1 Types of pain:
 3.1.1.1 Acute pain - is relatively brief, and subsides as healing takes place. May have duration of 1 second
   to less than 6 months
 3.1.1.2 Chronic pain - continues for a long period of time, generally is not curable, and can have
  episodes of exacerbation whereby certain activities or other conditions may cause the pain to reoccur. Has
  duration of more than 6 months.

4. PROCEDURE:

 4.1 The Registered Nurse
  4.1.1 Screen the patient at least once per shift during routine assessment by using the pain assessment
  tools. A pain scale can be used as needed to determine pain intensity (Appendix B: Pain Assessment Tool).
  4.1.2 Collaborate with the patient, family and interdisciplinary team to conduct the pain assessment
  utilizing a clinically appropriate instrument (Appendix A: Pain Assessment and Reassessment Tool).
    4.1.2.1 Upon receiving the patient
    4.1.2.2 When a patient exhibits a change in health status or pain is not relieved by initial
  interventions. For example, the patient:
    4.1.2.3 states he/she has pain
    4.1.2.4 is diagnosed with chronic painful disease
    4.1.2.5 has history of chronic unexpressed pain
    4.1.2.6 is taking pain-related medication for >72 hours
    4.1.2.7 has distress related behaviors’ (e.g. changes in anxiety level) or facial grimace.
    4.1.3 Initiate a written plan of care within 24 hours based on patient assessed condition and
  the location, type and patterns of pain episodes, previous history of pain and what was used to manage pain
  in the past (both pharmacological and non-pharmacological interventions), and contributing factors that may
  cause pain and allergies
  4.1.4 Reassessment of pain after medication should be done 30minutes post administration then 1 hour
  hereafter and should be recorded in the pain assessment flow sheet
  4.1.5 Nursing pain assessment and reassessment form should be accomplished initially upon receiving the
  patient or onset of pain and before transition of patient to the incoming shift nurse in charge
  4.1.6 Complete the care plan.
  4.1.7 Implement strategies to effectively manage pain including pharmacological and non-pharmacological
  interventions (e.g. positioning, distraction, relaxation, massage, aroma therapies, heat and cold).
  4.1.8 Document the effectiveness of the interventions.
  4.1.9 A pain monitoring flow sheet (Appendix C: Pain Monitoring Flow Sheet) can be used to monitor pain
  and determine the effectiveness of the pain management strategies over time.
  4.1.10 Monitor and evaluate the care plan at least 24 hours and more frequently as required based on the
  patient condition in collaboration with the interdisciplinary team. If the interventions have not been
  effective in managing pain, initiate alternative approaches and update as necessary.

5. RESPONSIBILITY:

 5.1 IHHC staff shall adhere with the above policy.

6. APPENDICES :

 6.1 Appendix A: Nursing Pain Assessment and Reassessment
 6.2 Appendix B: Pain Assessment Tool
 6.3 Appendix C: Pain Monitoring Flow Sheet

7. REFERENCES:

 7.1 Nettina, S.M. (2014) Lippincott Manual of Nursing Practice, 10th edition
 7.2 McQuay, H. (last updated 2002). Pain and its control. [On-line]. Available:
  http://www,jr2.ox.ac.uk/bandolier/booth/painpag/wisdome/C13.html
 7.3 Registered Nurses’ Association of Ontario. (2002). Assessment and Management of Pain. Toronto,
  Canada: Registered Nurses’ Association of Ontario. [On-line]. Available: www.rnao.org/bestpractices
 7.4 https://www.maplegrovehospital.org/stuff/contentmgr/files/0/00244701c3681b0bb0173c3ebd5f29aa/
  files/mgh_pain_management.pdf