Pain management—Continuum of care for surgical patients - Home Study Program

AORN Journal, Sept, 2003 by Sharon W. Chavis, Linda H. Duncan

The preoperative pain assessment record(Table 3)was enhanced to ensure that health care providers documented an acceptable comfort function goal as agreed upon by the patient. Comfort function goals help health care providers individualize a pain management plan for each patient and should be specific to the pain scale used. The form also was revised to improve documentation of education provided to patients about specific pain scales and overall pail management.

The perioperative nursing records specific to local surgery that may include conscious sedation were updated to include documentation for continued pain management assessment. Additionally, the sedation and analgesia form used in other areas throughout the facility, such as interventional radiology for invasive procedures, was updated to include pain assessment.

The postanesthesia care record for phase I recovery was revised to include documentation of pain management and assessments of patients in the PACU. Appropriate scales were incorporated in the form based on recommendations from the Centra Health pain council and current literature reviews. For example, the adult numeric (ie, zero to 10), faces pain rating, FLACC (ie, preverbal patient pain scale that evaluates face, legs, activity, cry, consolability) and sedation scales are used as deemed appropriate for each patient. (3-7) These scales have been incorporated into documentation forms and the teaching materials and tools provided. These scales also help patients and staff members determine the comfort function goal most appropriate for each patient. The form now identifies pain management intervention strategies and provides a final reassessment of patients' pain ratings before discharge from the unit. Patients predetermined acceptable comfort function goal is considered when assessing and managing pain postoperatively. The patients' comfort function goals are communicated throughout the continuum of care. In addition, the two PACUs discussed setup and initiation of patient-controlled analgesia (PCA) pumps in recovery before patient transport. The LGH campus was employing this practice; however, the VBH campus was setting up the pump but not delivering the initial bolus until after discharge and transport from the PACU. To establish the same standard of care and best practice, both campuses now setup and deliver the initial bolus in the PACU before transport.

The postoperative nursing record for phase II recovery also was revised to include intervention of pain management, sedation scales, and final assessment of patients' pain ratings before discharge from the hospital. Health care providers strive to achieve, at a minimum, patients' predetermined comfort function goals and pain ratings.

PATIENT AND FAMILY MEMBER EDUCATION. The chart audits performed in October 2001 revealed a lack of evidence of patient and family member education in regard to pain management and pain scales. The PI team evaluated the results of this audit, which reflected inadequate current educational materials and processes. Team members determined that current education practices needed to be enhanced, so they revised all major preoperative teaching booklets and incorporated a separate page dedicated to comfort and pain management instructions. A pamphlet titled Patient's Guide: Instructions for Comfort & Pain Management then was developed. This pamphlet included patient information on pain control techniques, including medications, use of cold and warm packs, diversions and distractions, elevation of extremity, and deep breathing with peaceful imaging. This tool was placed in all patient rooms in both surgery centers and was included in the patient teaching process in both preoperative education and testing centers. The PI team has established a future goal to have this pamphlet available for patients in surgeons' offices.