Pain: A Measure of a Patient's Well-Being
All doctors, nurses and health care workers know the four vital signs well. It's part of the daily routine to check blood pressure, pulse, respiratory and temperature for every patient. These measurements act as a barometer for a patient's health and are recorded on patient charts as reference for treatment. If the temperature is high, find out why and provide a fever reducer; if the lungs are congested, start looking for the cause.
Health care workers also look at a fifth vital sign — pain — as a measure of a patient's well-being. That might seem obvious. If someone is in pain, something is wrong. But there is no thermometer or stethoscope to measure pain. So how to measure it? When and how often to check it? How to treat it best? These questions are part of a national trend within health care to develop consistent measures for determining and treating pain. At Anne Arundel Medical Center, Nurse Manager for Oncology Elaine Kam, RN, MSN, along with a multidisciplinary team, is developing hospital-wide procedures for determining levels of pain, educating all care providers and patients about pain remedies and helping them become more involved in their own care.
Kam said these new procedures, which go into effect this summer, begin with initial questions during admission to the hospital. They may be as general as "Describe your pain on a level of 1 to 10, with 10 being the highest." The child version of the same question may be a row of faces, starting with a smiling face and ending with one in great pain. "We want to know about pain issues from the start, do an in-depth evaluation and work with patients to keep their pain at a tolerable level, or in the best case scenarios, completely eliminate it," she said.
Kam said national statistics indicate that many patients are inadequately treated for pain regardless of setting, and in spite of numerous advances in pain therapies. Improvement of pain management requires changes in health care institutions' policies and health care providers' policies, as well as better communication with patients.
"We have surveyed the clinical staff and physicians regarding pain knowledge and attitude to help develop our plan. Anne Arundel Medical Center is actually ahead of the game in many areas, but we are always looking for ways to improve," said James Caldwell, Pharm.D., clinical pharmacy coordinator and co-leader of the project.
"That doesn't mean we're just adding more drugs to our therapies. Pain relief comes in a variety of therapies other than drugs — massage, acupuncture, music, humor therapy and imagery," Kam said. (Imagery is the hallmark of the Lamaze method of childbirth where the mother focuses on an image to help relieve pain.)
The hospital has hired Lori Schmerr, RN, MS, who is a pain resource nurse to help with various pain relief therapies and to educate the staff, as well as the patients, in ways to relieve pain. The new procedures incorporate the entire health care team, nurses, pharmacists, spiritual care and social workers, physicians, and physical and respiratory therapists.
Kam said, "Taking care of pain isn't something new to the hospital. We've always addressed pain issues. The new procedures just help us to be consistent in measuring and managing patients' levels of pain and teaching them techniques to treat themselves. And, more than anything else, it's good patient care."