Pain 5th Vital Sign

Malaysian 5th Vital Sign Implementation: 2008-2010
DR LEE OI WAH PENGARAH HOSPITAL CHANGKAT MELINTANG
5th Vital Sign: Doctors training module: Intruduction
OBJECTIVE:
The purpose of module is to train doctors and nurses on pain assessment and pain management in order to implement pain as a 5th vital sign effectively in OUR hospital
All types of pain in all parts of the world are inadequately treated, be it acute or chronic, related to malignant or non-malignant etiologies.
Pain can be relieved in up to 90% of cancer patients, yet fewer than 50% receive adequate treatment National APS audit, Malaysia showed that 76% of postlaparotomy patients suffered moderate to severe pain in the 1st 24 hours What about patients in the medical wards or patients who have not had surgery?
New
standards in 2001 pain as the 5th vital sign
Record
Joint Commission on Accreditation of Healthcare Organizations. Jt Comm Perspect. 1999;19(5):68. Sklar DP. Ann Emerg Med. 1996;27:412413.
Pain should be considered the fifth vital sign

Patients should be assessed for pain every time pulse, blood pressure, temperature, and respiration are measured
American Pain Society Quality Improvement Committee. JAMA. 1995;18471880. th
5 Vital Sign: Doctors training module: Intruduction
Promote doctor-patient and nurse-patient interaction
Better communication Better patient satisfaction

Individualised carer Priority to pain assessment Better awareness of pain
Provide better patient care
better management of pain early ambulation faster recovery, reduced length of stay
Spectrum of Pain
ACUTE PAIN
Healing
NO PAIN
Insidious onset
CHRONIC PAIN
post-surgical, post-trauma syndromes cancer
ACUTE PAIN
CHRONIC PAIN
5th Vital Sign: Doctors training module: Pain Physiology
Pain Pathway
PAG / RAS
Descending inhibitory fibres
Sensory cortex
Thalamus
Ascending ST tracts
Free nerve endings Spinal cord

Dorsal horn Afferent nerve ( A / c)
Courtesy of Prof Ramani Vijayan, MASP
Main effects of severe unrelieved pain
Physiological
Increased stress hormones Negative effects on CVS, RS leading to increased risk of hypoxemia and myocardial ischaemia Increased risk of developing chronic pain conditions
Psychological
Anxiety and sleeplessness
Economic
Increased hospital complications, prolonged length of stay and increased costs
Malaysian 5th Vital Sign Implementation: 20082010
Why measure pain?
Produces a baseline to assess therapeutic interventions e.g. administration of analgesic drugs Facilitates communication between staff looking after the patient For documentation
5th Vital Sign: Doctors training module: Pain Assessment
Clinical techniques for measurement of pain
Self reporting by the patient (best method)
Observer assessment
Observation of behaviour and vital signs Functional assessment
Unidimensional scales
Numerical Rating Scale (NRS) Verbal Analogue Score (VAS) Categorical Scale or Verbal rating scale
Multidimensional scales
(not commonly used here)
Brief Pain Inventory (BPI) McGill Pain Questionnaire (MPQ) Memorial Pain Assessment Card
5th Vital Sign: Doctors training module: Pain
Combination Rating Scale (NRS & VAS) *Recommended for Ministry of Health*
On a scale of 0 10 (show the pain scale), if 0 = no pain and 10 = worst pain you can imagine, what is your pain score now?
Patient is asked to slide the indicator along the scale to show the severity of his/her pain, which is recorded as a number (zero to 10)
Wong-Baker Faces Pain Rating Scale
FLACC SCORE
WHEN SHOULD PAIN BE ASSESSED ?

1. At regular intervals as the 5th vital sign during routine observation of BP, heart rate, respiratory rate and temperature). This can be 4 hourly, 6 hourly or 8 hourly 2. On admission of patient 3. On transfer-in of patient 4. At other times apart from scheduled observations: Half to one hour after administration of analgesics and nursing intervention for pain relief During and after any painful procedure in the ward e.g. wound dressing Whenever the patient complains of pain
Who should be assessed?
All inpatients
Including patients in labour room, recovery room (OT), High dependency units, Coronary Care Units
All patients in Emergency department
Ambulatory care units
Exclusion
Patients in NICU
5th Vital Sign: Doctors training module: Pain
UNABLE TO ASSESS PAIN
Record
Unable to Score for adult cognitively impaired patients and unconscious patients
Observation Chart
Patients Name : Age : Ward :
DATE TIME BP PULSE RESP RATE
RN :
DOA :
TEMP
PAIN SCORE
ACTION TAKEN
COMMENTS
ANALGESIC LADDER: ACUTE PAIN MANAGEMENT
5th Vital Sign: Doctors training module: Pharmacology

Pain 5th Vital Sign

Uploaded by

Copyright:

Available Formats

Pain 5th Vital Sign

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pain 5th Vital Sign

Uploaded by

Copyright:

Available Formats

Malaysian 5th Vital Sign Implementation: 2008-2010

DR LEE OI WAH PENGARAH HOSPITAL CHANGKAT MELINTANG

5th Vital Sign: Doctors training module: Intruduction

5th Vital Sign: Doctors training module: Intruduction

standards in 2001 pain as the 5th vital sign

5th Vital Sign: Doctors training module: Intruduction

Pain should be considered the fifth vital sign

American Pain Society Quality Improvement Committee. JAMA. 1995;18471880. th

5 Vital Sign: Doctors training module: Intruduction

Promote doctor-patient and nurse-patient interaction

Better communication Better patient satisfaction

Provide better patient care

5th Vital Sign: Doctors training module: Pain Physiology

Free nerve endings Spinal cord

Main effects of severe unrelieved pain

5th Vital Sign: Doctors training module: Pain Physiology

Malaysian 5th Vital Sign Implementation: 20082010

Why measure pain?

5th Vital Sign: Doctors training module: Pain Assessment

Clinical techniques for measurement of pain

Self reporting by the patient (best method)

Observation of behaviour and vital signs Functional assessment

5th Vital Sign: Doctors training module: Pain

5th Vital Sign: Doctors training module: Pain Assessment

Wong-Baker Faces Pain Rating Scale

5th Vital Sign: Doctors training module: Pain Assessment

5th Vital Sign: Doctors training module: Pain Assessment

WHEN SHOULD PAIN BE ASSESSED ?

5th Vital Sign: Doctors training module: Pain Assessment

Who should be assessed?

All patients in Emergency department

Ambulatory care units

5th Vital Sign: Doctors training module: Pain

UNABLE TO ASSESS PAIN

5th Vital Sign: Doctors training module: Pain Assessment

5th Vital Sign: Doctors training module: Pain Assessment

5th Vital Sign: Doctors training module: Pain Assessment

ANALGESIC LADDER: ACUTE PAIN MANAGEMENT

5th Vital Sign: Doctors training module: Pharmacology

You might also like