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Pain Reassessment and Follow up Measures

Pain Reassessment and Follow up Measures. Christianah Adeyeye Nurse Extern KSU/Akron General. EBP Question. To what extent is pain reassessment being done and what is being done to control the pain?. PICO Statement. P- Patients in 8100 undergoing pain I- (a) pain reassessment

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Pain Reassessment and Follow up Measures

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  1. Pain Reassessment and Follow up Measures ChristianahAdeyeye Nurse Extern KSU/Akron General

  2. EBP Question • To what extent is pain reassessment being done and what is being done to control the pain?

  3. PICO Statement • P- Patients in 8100 undergoing pain • I- (a) pain reassessment (b) follow up measures implemented to decrease pain • C- Lack of pain reassessment and lack of follow-up if reassessment is not done • O- (a) determination of whether reassessment is being complete (b) Identify measures for follow-up being implemented

  4. Background Information • Patients put on call light for pain medication • Questioned if pain is being assessed • If pain level hasn’t changed, what is being done

  5. Akron General Compared to US/Ohio Hospitals How often was patients pain well controlled? How often did staff explain about medicines before giving to patients? Overnight hospital stays from Oct 07- Sep 08 Updated July 9th 2009

  6. Research Information • Literature • Nurses • Patients

  7. Literature • Pain is the 5th vital sign (Tapp & Kropp, 2005). • Pain should be reassessed 30-60 minutes after administration of pain medication. Delayed reassessment is the absence of assessment after 120 minutes (Okon et al., 2009). • Numerical pain scale utilized to determine pain levels • Mild pain rating is 1-4 • Moderate pain rating is 5-6 • Severe pain rating is 7-10

  8. Literature Con’d • Nurses play a critical role in pain management because they deliver direct patient care on a 24 hr basis • Many studies indicate that knowledge deficits and inadequate pain assessment are the most important barriers for health care professionals in implementing pain management (Zhang et al., 2008). • Pain management should include an accurate pain assessment and nursing documentation in the patient’s records (Tornkvist, et al, 2003).

  9. Nurses • Nurses say that its their responsibility to check to see if pain medication helps with patient’s pain. If not or pain level has not change, the nurse should consult with a physician to increase dosage, decrease intervals, or trying another medication (Potter & Perry, 2005). • Barriers reported to the delivery of pain management and pain reassessment 1. Inadequate staffing levels 2. Caring for too many acutely ill patients 3. Specific times of the day when they were too busy to provide care or to reassess pain levels (Tapp & Kropp, 2005).

  10. NursesHCAHPS Summary Information on 8100 Need Medicine for pain Yes- 57% No- 43% Early Summer 09 Quarter

  11. Patient Data • Data collected on 10 patients • Diagnosis • Medication • Time • Pain Level • Reassessment Time and Pain Level • Highest pain level recorded for patients with skeletal problems, UTI, and cellulitis • Type of medication that was recorded (Morphine, Oxycodone, Percocet, Dilaudid primary)

  12. Patient Data

  13. Analysis/Conclusion • Many nurses are assessing and reassessing but there are some that are not getting reassessed • Patients with severe pain levels (8-10) were still receiving the same pain medication • In calculating pain scores, following reassessment scores were observed: • 4 pts- were not reassessed • 1 pt- 2 point change • 1 pt- 3 point change • 1 pt- 4 point change • 1pt- did not have pain • 2 pts (2 & 4) were documented as “no signs of pain” which was 0 on the chart

  14. Recommendations • A computerized alert message to remind nurses to reassess pain levels on a patient 30-60 minutes after administration. Nurses get caught up in charting, patient care tasks, and many more that they can easily forget to reassess. • On 8100, nurses consistently document pain levels and reassessment. Nurses on 8100 should continue doing what they have been doing on controlling pain levels. • Further follow-up if pain medication is ineffective

  15. References Okon, T.R., Lutz, P.S., & Liang, H. (2009). Improved pain resolution in hospitalized patients through targeting of pain management as medical error. Journal of pain and symptom management, 37, 1039-1049. Potter, P.A., & Perry , A. (2005). Fundamentals of nursing.St. Louis: Mosby. Tapp, J., & Kropp, D. (2005). Evaluating pain management delivered by direct care nurses. Journal of nursing care quality, 20, 167-173. Tornkvist, L., Gardulf, A., & Strender, L. (2003). Effects of pain advisors': district nurses' opinions regarding their knowlegde, management and documentation of patients in chronic pain. Scandinavian journal of caring sciences, 17, 332-338. Zhang, C., Hsu, L., Zou, B., Li, J., Wang, H., & Huang, J. (2008). Effects of a pain education program on nurses' pain knowledge, attitudes and pain assessment practices in China. Journal of pain and symptom management, 36, 616-627.

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