“Medically Ready Force…Ready Medical Force” Screening for Pain in TSWF forms using the Defense and Veterans Pain Rating Scale (DVPRS) “Medically Ready Force…Ready Medical Force”

“Medically Ready Force…Ready Medical Force” Disclaimer The views expressed are those of the author and do not reflect the official policy of the Department of Defense (DoD), the U.S. Public Health Service, or the U.S. Government. “Medically Ready Force…Ready Medical Force” 2

“Medically Ready Force…Ready Medical Force” Learning Objectives At the conclusion of today’s activity, the participant will be able to: Accurately screen patients for pain using the Defense and Veterans Pain Rating Scale (DVPRS) Document DVPRS scores correctly in the electronic health record “Medically Ready Force…Ready Medical Force” 3

DVPRS Screening Questions DVPRS is the standard pain rating scale for the military health system DVPRS has 2 parts: Initial pain intensity question completed on all patients Four supplemental questions measuring impact of pain on activity, sleep, mood and stress to be completed on: Patients reporting a pain severity of 4 or greater* Patients not responding to the expected course of recovery A copy of the scale must be available for the patient to see each time it is used DHAPI 6025.04 (June 8, 2018) states a threshold of 5 or greater, however the DHA Pain Management Clinical Support Service, which is empowered by the referenced DHAPI, has stated that the DHAPI reference will shortly be changed to a threshold of 4 or greater, to which the TSWF content governance groups agreed. Information from DVPRS from Dvcipm.org *see speaker notes for explanation of this threshold “Medically Ready Force…Ready Medical Force”

Properly Delivering DVPRS Pain Intensity Question When using DVPRS, the screener will: Point out the scale components Faces Color coded bars Word descriptors Allow patient time to: Look at the scale Read the word descriptors Ask: “Look carefully at the pain scale. How would you rate your pain right now?” Document responses in TSWF CORE form (see slides 13-15) Information from DVPRS from Dvcipm.org “Medically Ready Force…Ready Medical Force”

“Medically Ready Force…Ready Medical Force” DVPRS Supplemental Questions for Pain Intensity Score of Four or Greater When pain intensity response is four or greater: Orient patient to supplemental questions, used to assess functional impact Instruct patient, “Using these 0-10 scales, answer the following questions about the last 24 hours.” Supplemental questions are not applicable when pain began earlier in the day of appointment Document DVPRS responses in the TSWF CORE Form (see slides 13-15) “Medically Ready Force…Ready Medical Force”

Appropriate Use of DVPRS: Patient Population Should be used with adult patients Has not been tested in pediatric patients or patients with cognitive impairment Consider appropriateness of use in patients with traumatic brain injury who are experiencing short-term memory loss. These patients may be able to answer their pain intensity “right now,” but may be unable to give information on average pain over 24 hours or the supplemental questions Patients with color blindness should be oriented to other features of the scale Information from DVPRS from Dvcipm.org “Medically Ready Force…Ready Medical Force”

Effective Screening Practices Preferred: show the hard copy; alternative: read questions verbatim Questions were studied how they are written on the form Changing a question’s wording can alter its meaning and the PCMH team’s understanding of the patient’s pain experience Do not comment or offer feedback after a patient’s responses (e.g., “okay, good”, “that’s great”, etc.) Comments provide feedback to a patient (e.g., that is good that you do not have pain) Comments may imply that a patient should or should not share information with you in the future “Medically Ready Force…Ready Medical Force”

Case Example #1 DVPRS Pain Intensity Items SGT Carson is a 35-year-old man who presents for a primary care appointment for cough. The screener administers the DVPRS pain intensity items: Pain right now Screener: “Look carefully at the pain scale. How would you rate your pain right now?” SGT Carson: “Five” Since the response is greater than 3, administer supplemental questions “Medically Ready Force…Ready Medical Force”

Case Example #2 DVPRS Supplemental Questions “SGT Carson, I am going to ask you a few additional questions. Using these ‘0-10’ scales, answer the following questions about the last 24 hours.” “Medically Ready Force…Ready Medical Force”

“Medically Ready Force…Ready Medical Force” Group Discussion… Why is it important to ask all screening questions “verbatim,” meaning exactly as written? Why is it important to ask the DVPRS supplemental questions when patients have a pain intensity score of 4 or greater? “Medically Ready Force…Ready Medical Force”

Using Your Workflow Knowledge Check: The patient is a 47-year-old beneficiary with a scheduled appointment for sleep disturbance. The patient’s rating on the pain intensity item is three. What action does the screener take? Your patient is a 58-year-old woman with chronic low back pain for three months. She reports her current pain intensity as five. What action does the screener take? “Medically Ready Force…Ready Medical Force”

Documenting DVPRS Scores in the TSWF CORE Form New ribbon in the HPI tab, TSWF CORE form: Use DVPRS in all cases except when inappropriate (see slide 7); in that case use the traditional 0-10 pain level “Medically Ready Force…Ready Medical Force”

Documenting DVPRS Scores in the TSWF CORE Form Linked reference: Link: http://www.dvcipm.org/site/assets/files/1084/dvprs_single_page.pdf “Medically Ready Force…Ready Medical Force”

Documenting DVPRS Scores in the TSWF CORE Form When the DVPRS ribbon is opened, additional pain documentation fields are revealed, including the new DVPRS supplemental questions to assess “functional impact” Note this clinical cue: manually open the ribbon when needed The ribbon contains the DVPRS supplemental questions and the full pain assessment, and space for documenting pain reassessments. These were all placed in the same ribbon to conserve space on the form while easing the access to these supplemental pain assessment needs. “Medically Ready Force…Ready Medical Force”

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TSWF Content Management Sub-Working Group CHAIR - Maj Matthew J Royall ARMY - Dr. Robert Marshall NAVY - CDR Anja Dabelic AIR FORCE - Lt Col Thomas Mahoney DHA – CPT Hudson-Odoi TSWF Feedback https://www.milsuite.mil/book/groups/tswf TSWF Website http://www.tswf-mhs.com/