1. Interdisciplinary Management of Pain Greater Baltimore Medical Center

2. Definitions Acute Pain: generally time-limited, and is responsive to opioid and non-opioid therapy Chronic Pain: exists beyond its expected time frame for healing or where healing may not have occurred; It is persistent pain that is not amenable to routine pain control methods

3. Pain Policy at GBMC All patients treated at GBMC will receive appropriate analgesic care All patients treated at GBMC will be assessed for the presence of pain, in both inpatient and outpatient areas

4. Assessing Pain Patient’s self report will be the standard used in assessment Assessment begins on admission for pain and acceptable level of pain while hospitalized Pain is to be assessed/reassessed at the following intervals: −After any known pain producing event −With each new report of pain −Following therapeutic intervention −In accordance with the algorithms for acute and chronic pain −With the daily assessment (q8h) if pain is not present on admission

5. Other Considerations All patients will be assessed q8h for any associated symptoms of pain control therapy −nausea, itching, constipation, over-sedation, and inability to void Placebo use for pain control is not allowed Patients and family should be educated on the right to pain management, interventions to relieve pain, and their role in managing pain

6. Pain Consultative Services Department of Anesthesia will consult for: −Acute Epidural Analgesia −PCA pumps Department of pediatrics will consult on any patient under 16 years of age

7. Pain Education Patient education tools will be made available to all patients upon admission −“What Patients and Families need to know about Pain Management” (Form # 34680) −“What Parents need to know about Pain Management” (Form # 34681) Nurse is responsible for assessing educational needs and developing and educational plan based on: −Plan of care −Patient goals −Culture −Age −Developmental Stage

8. Pain Screening Tools Visual Analogue Scales are used to screen patients For patients unable to self report, behavioral scales are used Non-English speaking patients are screened using language specific pain tools, an interpreter, or the assistance of the AT&T Language Line Pain Scales used at GBMC −Numbers scale (0-10) for adults −Faces scale for children 3 years and older −FLACC Scale for 3 months – 3 years −NPASS Scale for neonates

9. Pain Documentation Pain Assessment/Reassessment is documented in Meditech PCS −Admission Database −Pain Assessment/Reassessment Intervention Includes the following information: −Intensity of Pain −Description of Pain −Location of Pain −Aggravating / Alleviating Factors −Associated Signs / Symptoms −Impact on Functional Ability −Methods of pain management that have been useful in the past −Patient’s personal goal for pain management

10. Pain Documentation Pain Reassessment is documented in Meditech PCS −Pain Assessment/Reassessment Intervention Reassessment occurs on the following recommended intervals: −Oral Medications: within 60-90 minutes after dose administered −Intramuscular/Subcutaneous Medications: within 60-90 minutes after dose administered −Intravenous Medications: within 30-60 minutes after dose administered Any pain medications administered are documented on the MAR in Meditech

11. Patient Controlled Analgesia (PCA) Pumps The CADD Prizm Pain Control System is used to deliver continuous (basal rate) dosing and/or patient administered (bolus)doses. Two RNs are required to independently double check orders and pump settings at each order change, change of shift, prior to transfer of patients between units, and when receiving a patient upon arrival to the unit PCA cassettes are supplied by pharmacy (found in AcuDose, delivered by the pharmacy to unit, or picked up by the nurse at Pharmacy if not premixed) PCA pumps are obtained from Central Sterile Supply All PCA documentation is entered into Meditech PCS in one of the following interventions, as appropriate: −IV PCA Flowsheet (for Morphine and Dilaudid use) −Epidural PCA Flowsheet (for Epidural PCAs) −IV Fentanyl PCA Flowsheet (for Fentanyl use only)

12. More Information Please review the pain tools document found on the www.gbmc.org site – listed with the Pain Self Learning Packet and testwww.gbmc.org Please take the Pain SLP Test and submit certificate of completion to agency