Pain – Entry 4

Dear Diary,

We continue to try new approaches for helping residents manage their pain. One of our long-stay neighborhoods has worked hard to individualize approaches to pain management. Every time a resident requests a pain med, the staff offers a non-pharmacologic approach. They individualize the approaches based on resident preference and what seems to help. For example, around 2:00 today Leo complained of hip pain and asked the nurse for a pain pill. The nurse got a good description of his pain and, in addition to providing the pain pill, helped him lie down when he asked. About a half hour after the nurse gave Leo the pain medication, she went back to Leo to see if he was feeling better, and he was. The nurse and the nursing assistant have noticed that Leo has increased complaints of hip pain in the afternoon. So, they talked with Leo and all agreed that starting tomorrow, they will offer to help him lie down after lunch to see if this will prevent him from having hip pain. Leo’s open to trying anything that will help, so they discussed ice and heat packs, distractions like music and TV, and trying some different chairs to aid his comfort. They’ll try these different approaches and document what helps. Since this pain is pretty recent, the nurse did a more thorough assessment. She will contact Leo’s physician with her findings and see if some therapy would be appropriate. This team approach has worked well for residents who are able to communicate.

This neighborhood also has been able to reduce the number of PRN pain meds given by doing thorough pain assessments including intensity and duration. They discovered a few residents with chronic pain related to joint and soft tissue changes. So, they consulted with our pharmacist and physician to see if these people would benefit from scheduled pain meds. They’ve got a good titration system starting with scheduled acetaminophen and adding other pain medications as needed for relief. The pharmacist makes recommendations based on the resident’s diagnoses and current medications. The nurse contacts the physician with the recommendations. It’s been going well. We have more residents on scheduled acetaminophen, which is helping a fair number of them with chronic pain issues.

I think I’ll have these nurses talk at our next nurses meeting. I’ll ask all the nurses for their input and see if we can spread these approaches to another neighborhood.

I wonder what other homes are doing to reduce pain.

Signed, Donna

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