To manage pain, combine assessment with education
Communication key for successful management
Teaching patients about pain management is an important part of their education, yet many institutions have trouble meeting this education standard required by The Joint Commission in Oakbrook Terrace, IL.
Standard RI.2.160, located in the Ethics, Rights, and Responsibilities Chapter, states that patients have a right to pain management. This means patients are assessed for pain, and they and their family members are educated on their role in order to manage pain.
To help staff at the University of Texas M.D. Anderson Cancer Center in Houston meet this standard, an Interdisciplinary Plan of Care & Teaching Record on pain was implemented, says Louise Villejo, MPH, CHES, executive director of the patient education office.
The teaching plan has a list of topics to cover with the patient and caregiver, as well as teaching materials that can be used in the education process.
Patients are instructed on the following:
- The right to pain assessment and management.
- Their role and responsibility in pain management.
- Side effects and schedule of administration of medications.
- Bowel management plan to prevent/manage constipation.
- The need to take a stimulant laxative and stool softener to offset the side effect of pain medication.
- Use of pain scale.
- Substituting over-the-counter analgesics for prescribed analgesics, as directed by physician.
- Taking prescribed analgesics as ordered.
- Notifying physicians/RN if pain continues.
- Tapering prescribed analgesics, as discussed with physician.
- Clinical contact information.
- Referral to pain management class.
The following educational materials are reviewed with patients:
- Numerical pain rating scale.
- Guide to managing cancer pain.
- Partners in care: Controlling your pain (video).
- Bowel management when taking pain medication and other constipating medications.
- Bowel management, a guide for patients.
- Preventing constipation.
The first step to managing pain is a thorough assessment, says Jane Taubert, RN, MSN, AOCN, a clinical nurse specialist at M.D. Anderson Cancer Center.
The assessment that patients are given upon hospital admission includes the use of a pain rating scale, as well as a series of questions. One pain scale has patients rate their pain on a scale of zero to 10.
It also has a description of pain and is available in English and a few other languages, such as Spanish and Chinese.
Patients are questioned about the location of their pain, as well as the level of pain at each location. They are asked what helps to relieve pain, such as elevating their legs.
"We start where the patient is and learn how we might improve it. Sometimes pain is well-controlled from the patient's perception," says Taubert.
All surgical patients are seen by staff in the acute pain service, and those that continue to have trouble controlling pain are referred to the chronic pain service.
Different choices for pain control are offered, such as guided imagery or acupuncture, because not all patients want to take pain medications or need to take them, explains Taubert.
Part of the education process is to help patients understand they must adhere to the planned regimen in order for their pain to be effectively controlled.
Taubert says patients often don't see the value of setting an alarm to wake up in the middle of night to take pain medication at the prescribed time, yet it may be required in order to manage pain well.
To manage pain, there must be a great deal of communication between patients and clinicians.
"The patient is an important player in pain management. We must keep the patient informed, and they must keep us informed. It is a two-way street," says Taubert.
SOURCE
For more information about educating patients on pain management, contact:
- Louise Villejo, MPH, CHES, Executive Director, UT M. D. Anderson Cancer Center, Patient Education Office, 1515 Holcombe – 21 Houston, TX 77030. Telephone: (713) 792-7128. E-mail: [email protected].
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