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Re: Pain managementFrom: Henry Gregor (henrygregor@yahoo.com)Wed Mar 29 10:28:05 2006
Intersting thoughts, all...in light of Grace's comments...years ago it seemed a struggle to avoid patients' repetitively hearing remonstrations and disincentives to accepting epidural analgesia, even with patients having obviously horrific labor pain not responsive to psychoprophylactic or parenteral options. Now, its tough for a patient not wanting an epidural to get through a delivery without being subtly or overtly encouraged to epidural use, and three plus hour second stages with stressed out patients and family are more and more common...oh well, must another aspect of geezer hood sounding off here. H Grace Loehr <divinegracie@earthlink.net> wrote: I agree with you but of course it's not a culture of "better" living through pharmaceuticals, it's a culture of pushing more drugs, it seems at times. As a nurse I understand that JCHAO has emphasized the pain scale and pain relief and has dinged hospitals for not adequately addressing pain management. The result is every hospital I've worked in in the past few years requires RNs to assess pain, using that 0/10 scale, on a regular basis (my present hospital requires double charting on it Q 2hrs!!!!). The pts get tired of being asked. I think it's counterproductive, esp. in labor and birth, where the patients go up to 10 rather quickly ... and PP I think it's obsessive and helps them focus on their pain more than they should. My assessment of pain can be quite different from the pt's, based on what I observe of them. My hospital also hands out the 7.5mg Lortabs, not the 5mg we used to routinely give post op joint replacements (pretty painful postop course) ... what's up with that? The increase in epidurals can't be coincidental either. In fact, the group of patients I've had who routinely are able to do without pain meds or epidurals are those from outside the USA. Must be different cultural attitudes towards pain, birth, &c that enable them to cope -- it'd be interesting to see research on this. Suggestions on how to get rid of that pain scale, or on how to better address this issue than by handing out more and stronger pain meds? Grace RN Lynn Montgomery: Now I have been been doing scopes for 18 years. Over that time, I have seen a progressive increase in the requirement for post-operative pain management, despite my procedures being exactly the same. In the recovery room, patients are requiring much more immediate post-op pain medication. I now discharge patients with Lortab 7.5 mg, #30 and quite routinely get called on post-op day 3 or 4 for a refill - which I typically refuse. I place part of the blame on the hospital's use of its "Pain Scale", where they counsel patients pre-operatively on gauging their pain on a scale from 1-10. They are taught that if "they" feel they are greater than a 4-5, their pain is not adequately controlled. Nursing staff doesn't do their own assessment any longer, but rather relies on the patient's own assessment of their pain - hell when the recovery room nurses call to advise me of a patient's post-operative pain, they don't even know the patients vitals. It seems that we have created a culture of better living through pharmaceuticals and we are expected to provide the remedy.
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