The # 1 reason for failure to treat pain in LTC is the failure to detect it.

Resident related barriers

• Misconception that pain is a normal part of aging

• Belief that suffering is punishment for past actions

• Fear that pain means new or worsening disease

• Concerns about not being a “good patient”

• Fear of addiction or being thought of as an addict

• Worries about unmanageable side effects

• Language and cultural barriers and beliefs

Communication Barriers

• C.N.A. reports are often ignored, not included in shift reports

• Nurse does not ask if the resident is having pain, so few PRN medications are given

• Shift-to-shift conflicts about the treatment plan, based on own personal beliefs

• Nurse to physician incomplete information, non-specific requests

• Nurse assessment of pain, verbal and non-verbal in incomplete or insufficient

What is Pain? "Pain is whatever the experiencing person says it is and it exists whenever he/she says it does.”

Pain screening interviews

• Do you feel pain anywhere right now?

• Does pain stop you from doing things you enjoy?

• Does pain keep from sleeping at night?

• Do you have pain everyday?

Pain Rating Scale

Numeric pain scale

Assessing pain

• Many residents have more than one source of pain so may require more than one approach to pain management.

• If pain is identified upon a screening, then a comprehensive pain assessment should be completed.

Pain screening Timing

• Each time vital signs are taken

• Each time a treatment is performed

• Each time pain medication is given (routine or PRN)

• Each time an invasive procedure is performed

• Anytime a resident has a non-verbal or verbal sign of pain

• With any change of condition

• With any admission or re-admission

• With any adverse change in behavior

Pain screen Documentation

• On the back of the MAR
• On the back of the TAR
• On the 24 hour shift to shift report
• In the nurses notes
• On the vital signs flow record
• On the monthly summary
• On the skilled nurses notes
• On interdisciplinary notes

Type of pain scale

• When screening for pain it is necessary to document the type of pain scale used and to use the same pain scale consistently.

Comprehensive Pain assessment

• Regular intervals for all residents

• With any new complaint or sign of pain

• With any increase in pain or

• With any sign or report of unrelieved pain

• With any fall incident

• With new admissions

• With re-admissions

• With any change of condition

Communicate!

• Tell the physician

• Tell the resident

• Tell the family

• The your co-workers

• Recognize the pain

• Treat the pain

• Evaluate the treatment

• Revise the pain plan

Re-assess

• At regular intervals

• With any complaint of increasing pain

• Following any change of condition

• With changes in behavior

• With decreased physical functioning