Version No / 1.0
Version Date / 22/1/15
Review Date / 22/1/17
GUIDELINES FOR ASSESSING PAIN IN PATIENTS
1. Within DCHS 3 pain assessment tools have been provided to help meet patient’s individual needs:
i. PAIN ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO COMMUNICATE – this tool should be suitable for most patients as it contains a body map to help patients identify the location of any pain and a pain scale to measure the intensity of the pain
ii. PAIN ASSESSMENT TOOL FOR PATIENTS WITH COGNITIVE IMPAIRMENT (Abbey Pain Scale) – this is an observational pain assessment tool for use with patients who are unable to communicate due to Cognitive Impairment e.g. Dementia. It requires staff to observe the patient’s behaviour for signs of distress, pain and discomfort. It can be used alone or in combination with any of the other pain assessment tools to form a complete individualised pain assessment. Separate guidelines have been provided on how to use this tool – see GUIDELINES FOR USING THE PAIN ASSESSMENT TOOL FOR PATIENTS WITH COGNITIVE IMPAIRMENT (Abbey Pain Scale).
iii. PAIN ASSESSMENT TOOL FOR USE WITH FAMILY AND CARERS OF PATIENTS WITH COGNITIVE IMPAIRMENT – this tool is also designed to identify pain in patients who are unable to communicate due to Cognitive Impairment. It needs to be completed with the patient’s family and carers to help identity known signs to observe for when the patients is in pain or discomfort. There is a separate section for recording interventions that have been found to help relieve the patient’s pain, distress and discomfort. This tool can also be used in combination with any of the other tools to provide additional guidance and information for staff on pain assessment and treatment.
FLOW CHART FOR ASSESSMENT OF PAIN IN PATIENTS - has also been provided with factors to consider and general guidance on assessing patient pain, including when to use the pain tools provided
2. Self-reporting of pain is the “Gold Standard” method for identifying pain in patients including those with mild to moderate Cognitive Impairment. For these patients use “PAIN ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO COMMUNICATE”
3. In patients with Cognitive Impairment where communication is a problem using an observational pain assessment tools is “The Gold Standard” e.g. use “PAIN ASSESSMENT TOOL FOR PATIENTS WITH COGNITIVE IMPAIRMENT” (Abbey Pain Scale) and/or “PAIN ASSESSMENT TOOL FOR USE WITH FAMILY AND CARERS OF PATIENTS WITH COGNITIVE IMPAIRMENT”
4. When considering which observational pain assessment tool/s to use you need to ensure that it will help to identity:
a) the type of pain
b) location of pain
c) Intensity of pain
5. Know the individual
a. behaviours that may indicate distress
b. underlying medical conditions e.g. pressure ulcers
c. how their distress affects their activities and participation
6. Consider that older patients are often more reluctant to report pain and are often used to “putting up with it”
7. Pain assessment involves the whole team in partnership with the family when deciding which pain assessment tool/s to use and the care and treatment to be implemented
8. Where patients are experiencing pain a care plan must be completed, detailing the pain scoring tool to be used, the frequency of the review and interventions identified to help relieve pain.
9. Assessing the patient regularly is essential as their needs may change due to deterioration or improvement. This should be at every visit for patients within the community and at least daily for in-patients depending on individual requirements.
10. Patients behaviour should be observed for at least 5 minutes particularly during physical activity as this can help identify particular types of pain such as musculoskeletal
11. Don’t forget the patient’s distress may be emotional/physical/psychological. What is a minor issue for one patient may be a major problem for another
12. Evaluate the situation – is distress caused by:
a) the environment e.g. is the patient new to the ward
b) other patients
c) fear, anxiety, anger, frustration
13. If the patient appears to be in pain can they tell you, can they point to where the pain is or use a “Pain Map” e.g. “PAIN ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO COMMUNICATE”
14. Patients may use other words for pain e.g. sore, hurting, and aching. Consider using cards or charts with words patients can point to
15. To identify the severity of pain use a pain scale that the patient can point to e.g. use “PAIN ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO COMMUNICATE”
16. Are there non pharmacological options that could be used
d. pressure relieving cushion/mattress
e. positional change
f. patient too warm/cold
g. supporting the patient with pillows
h. consider other therapies
17. Treat/manage the likeliest cause of the patient’s distress
18. The goal is a reduction in the number or severity of the signs of distress
19. Trial prescribed medication and note the effects, consider alternative medication if necessary e.g. if effects are not lasting try slow release formulas
20. A second evaluation should be conducted one hour after any intervention taken in response to pain, to determine the effectiveness of any pain-relieving intervention.
21. If, at this assessment, the score on the pain scale is the same, or worse, consider further intervention and act as appropriate.
22. Complete the pain scale hourly, until the patient appears comfortable, then four-hourly for 24 hours, treating pain if it recurs.
23. Record all the pain-relieving interventions undertaken.
24. Evaluate the patient’s care plan and the pain tool used and review if necessary
25. If pain/distress persists, undertake a comprehensive assessment of all facets of patient’s care and monitor closely over a 24-hour period, including any further interventions undertaken. If there is no improvement during that time, notify the medical practitioner /prescriber of the pain scores and the action/s taken and up-date care plan accordingly.
References
· NICE Guidelines
· Royal College of Physicians, British Pain Society and British Geriatrics Society Guidance on; The assessment of pain in older people 2007