Palliative Care and Pain Management - Trinitas Hospital

Palliative Care
And
Pain Management
Revised: bw/September 2010

Palliative Care
• Symptom management is a primary goal of
palliative care.
• Pain is one of the most feared symptoms
experienced by patients.
• Effective pain management is critical to
healing, quality of life and patient
satisfaction.

Key Concepts in Pain Management
1. Assessment
a) reassess to prevent pain, not prn.
2. A multi-disciplinary approach.
3. Using pain relief methods effectively.
4. Educating patients and their families.

Trinitas Pain Management Policy
• All patients will be assessed for pain upon admission
and at least once every 8 hours for inpatients and with
each clinic visit for out patients.
• The clinical staff will work together with the patient to
establish a goal for pain relief and develop and implement
a plan to achieve that goal.
• Patients and their families will receive education about
pain management to enable them to be active participants
in their treatment plan.
• Pain management will be incorporated into the
discharge plan.

The Pain Management Team
• Physicians
• Nurses
• Physical therapists
• Occupational
therapists
• Mental health
professionals
• Social workers
• Pharmacists
• Religious or Spiritual
leaders
The Patient is part of the team, too!

What Is Pain?
• Pain is physical
– Damage to nerves and tissue due to disease, injury
or infection
• Pain is emotional
– Stress, anxiety, trauma and depression play a role
in a person’s suffering
• No two people are the same
– Two people with the same injury (or surgery)
can experience different levels of pain
• Some pain has no clear cause

Pain Relief Methods
Used alone or in combination, include:
• Medication
• Cognitive and behavioral techniques (guided
imagery, for example)
• Exercise.
• Physical agents (massage, heat and cold, etc.)

Education of Patients and
Families
Patients and families
must understand:
• The different types of pain and
pain relief options
• The importance of reporting
their pain
• Why pain relief is important for
recovery
• The effectiveness of pain
control measures
Barriers to effective pain
education and management:
• Fear of addiction
• Fear of legal problems
• Worries about side effects
• Cultural beliefs

Pain Assessment:
• Many factors play a role in pain assessment for
both the person being assessed and the person
doing the assessment.
• These factors include:
– Culture
– Age
– Sex
– Previous pain experiences
– Fears and feelings about tolerance, dependency and
addiction

0 – 10 Numeric Scale
• For use with adult patients &
children age 7 and older
– 0 indicating no pain and 10
indicating the worst possible pain
– Available in different languages
– Patient must be educated in the use
of the tools
– Tools made available to patient and
family for reference

The Faces Scale (Wong-Baker)
• For use with pediatric
patients, ages 3-18
– Can also be used with
adults
– 0 indicating no pain
and 10 indicating the
worst possible pain
– Children must be
taught how to use tool

FLACC Scale
– A behavior pain assessment for use in non-verbal
patients who are unable to provide reports of pain
– Ratings are obtained in each measurement
category. Scores are added together and a total
pain score is obtained from 0-10
– For use with adult patients who are cognitively
impaired and for children ages 2 months to 7
years

FLACC Scale
FLACC Scale
Scoring
Categories
0
1
2
Face
No particular expression or
smile
Occasional grimace or frown,
withdrawn, disinterested
Frequent to constant quivering
chin, clenched jaw
Legs
Normal position or relaxed
Uneasy, restless, tense
Kicking, or legs drawn up
Activity
Cry
Consolability
Lying quietly, normal position,
moves easily
No cry (awake or asleep)
Content, relaxed
Squirming, shifting back and
forth, tense
Moans or whimpers;
occasional complaint
Reassured by occasional
touching, hugging or being
talked to, distractable
Arched, rigid or jerking
Crying steadily, screams or
sobs
Difficult to console or comfort
Each of the 5 categories ( F ) Face; ( L )Legs; ( A )Activity; ( C ) Cry; ( C ) Consolability is scored from 0-2, which results in a total
score between zero and ten.

Documentation:
• On Admission, the initial patient assessment
will include:
• Duration
• Intensity
• Aggravating/Alleviating Factors
• Location
• Character/Quality
• Effect on ADL’s & quality of life

Documentation:
• Daily assessment:
Patients will be assessed
at the beginning of
each shift and as
necessary
Pain assessment will be
located with the other
scheduled assessments
in the clinical
documentation system
• Medication
documentation
– Upon charting pain
medications, document
pain scale prior to
administering medication
– Reassess for effectiveness
of medication