Many healthcare professionals consider pain management critical not only to a patient's recovery but also to his or her positive engagement with a healthcare facility. A healthcare provider's ability to understand and respond appropriately to patients' pain affects those patients' overall experience with their care provider. Hospitals should make sure that there are policies in place that answer the following questions:
Pain management must address both the physical and emotional symptoms of pain.
- What methods do we use to manage pain?
- Do our patient-facing healthcare professionals have a good understanding of a patient's personal or spiritual needs regarding pain management?
- What alternatives to medication do we discuss with patients, and how do we stay current in this area?
- How can we ensure that discharged patients will be able to properly manage their pain?
In working with more than 600 leading healthcare providers around the world on patient engagement, safety, and experience, Gallup has discovered that these are best practices related to pain management:
Patient and staff interventions
- Set patient expectations appropriately. Pain control doesn't necessarily mean the absence of pain. Sometimes a certain level of pain is necessary to properly diagnose and treat a condition.
- Anticipate the pain medication schedule. Don't wait for patients to ask for pain medication. Visit patients before it is time for their next medication to ask them their level of pain, and be prepared to administer the next pain medication.
- Stay in constant communication with patients while trying to control their pain. Ask yourself, "Have I done everything I can to control this patient's pain?" You should also be aware of and treat symptoms that might be associated with pain management. Different cultures have differing tolerance of or willingness to reveal pain. Cultural sensitivity includes talking about pain with patients and their family, being aware of differences in sensitivity, and building a relationship with patients to encourage them to communicate about their pain.
- Understand that pain is emotional as well as physical. Pain management must address both the physical and emotional symptoms of pain. For example, a cancer patient is awake and in pain during the night. Although she is in physical pain, emotional distress is keeping her awake. A good nurse will sit beside the patient, hold her hand, and say, "I understand."
- Record current pain levels on a whiteboard. Noting pain levels where patients and staff can see them facilitates staff communication and coordination. In many hospitals, for example, a whiteboard is placed at the foot of the bed or on the wall where the patient can view it and staff members have easy access to it. Staff members update the board with key information, such as the nurse's name and the patient's pain level at each round or check-in. Staff members can use this information to answer questions about the patient's pain levels when discussing treatment options with the patient.
- Educate patients about how to manage their pain after being discharged. One hospital discovered that most patients who called the hospital the day after they were discharged reported that they were in pain, even though the pain was under control when they left the facility. Further investigation revealed that patients were failing to take their pain medications as prescribed. Some thought the prescription would be expensive, so they tried to avoid the expense and did not get the prescription filled; others filled the prescription but rationed their pain medication by taking it when they felt they needed it instead of according to schedule. Because pain pills do not work immediately, the delay in taking the medication caused patients' pain to increase dramatically. Hospital staff used two tactics to help patients understand why they needed to take their medication on schedule after discharge. First, they printed the warning "If you do not take your pain medicine, you will be in pain" in bold at the top of the written discharge instructions. Then, during discharge, a staff member verbally cautioned patients, "If you do not take your pain medicine, you will be in pain." This may seem blunt, but patients needed this message in language that was easy to understand.
Staff and hospital interventions
- Initiate a pain-control policy. Healthcare professionals must be familiar with their hospital policies and openly discuss pain control with patients and their families. Consult with patients about methods that have -- and have not -- worked well in the past. Patients also should have a chance to voice their concerns about medications and how to administer them. When appropriate, healthcare professionals should discuss their roles in managing pain and the potential limitations and side effects of treatment with patients and their families.
- Review the process for pain medicine delivery from the pharmacy to the nursing unit. Pay particular attention to off-shifts and weekends. Poor coordination or the lack of timely delivery between the pharmacy and the nursing unit is a frequent cause of patient pain. Both the nursing staff and the pharmacy should look at communication policies and procedures to ensure that medication is available or delivered promptly when patients need it. Many hospitals have adopted Toyota's "lean" approach to quality management; this review process could prompt a joint lean project between the nursing staff and the pharmacy.
- Educate all hands-on providers about pain assessment and management. Proper education for providers results in a cohesive pain-management program for patients.
- Become familiar with non-medication pain control to provide patients with "high-touch" pain management options. The American Nurses Association (ANA) differentiates between medication and non-medication pain management. Teach patients breathing exercises and the benefits of massage, positioning, cold pack care, and relaxation. All of these are high-touch ways to provide patient-friendly care.
Pain is a major barrier to engaging patients during their hospital stay and after they are discharged. Following best practices in pain management will result in better clinical outcomes because patients will be more engaged in their care and more likely to follow instructions after they leave your care.
A version of this article originally appeared in Middle East Health.