Re: ACOG Antepartum Record - Pain Scale?
From: Joanne Bulley, MD (islesannie@gmail.com)
Wed Nov 21 16:50:02 2007
How totally True.
Walt Kelley and the Pogo comic strip were just favorites of my family.
Joanne
At Wed, 21 Nov 2007, art fougner, md wrote:
>
>"We have met the enemy. And they is us."
>Walt Kelley
>
>Art
>
>At Wed, 21 Nov 2007, Lynn Montgomery wrote:
>>
>>I agree completely with Charlie. The hospital pain scale is one of the
>>worst mandates to healthcare in my career. In our hospital, it has
>>resulted in the following:
>>
>>1. Nurses no longer pay attention to vital signs; they simply ask
>>the patient for their estimate of pain - even to the point of waking a
>>sleeping patient to ask them how the rate their pain.
>>
>>2. When I get called for a patient "with uncontrolled pain", I
>>always ask for their vital signs, reasoning that if the pulse and blood
>>pressure aren't up, there is likely a disconnect between the patient and
>>the evaluating nurse. Invariably, the nurse calling does not have the
>>vitals available and has to go check - they haven't even evaluated the
>>patient. After all, an over-medicated patient doesn't ring the nurse
>>call button much!
>>
>>3. The pain scale has resulted in the hospital creating a "Pain
>>Team" to specifically deal with patients who complain of "uncontrolled
>>pain". Physicians who have grown weary of the numerous nursing calls
>>for "uncontrolled pain", based on their pain scale assessment, can now
>>just write an order for the Pain Team to be consulted "as needed". This
>>results in significant additional costs to the patient, who typically
>>just gets her analgesic changed to Dilaudid with Toradol.
>>
>>4. A postoperative patient in our hospital continued to complain
>>of excruciating pain based on the pain scale and was repeatedly given
>>narcotics without appropriate monitoring and was later found dead
>>secondary to respiratory arrest.
>>
>>a. During a review of this case, a point was made regarding the
>>contribution of the pain scale to this patient's demise, but despite
>>this, the solution was not to re-address the scale, but rather to get
>>more oximeters with louder alarms so that patients with respiratory
>>depression secondary to analgesic therapy would be detected before they
>>die...
>>
>>Lynn
>>
>>--
>
--
Joanne Bulley, MD, FACOG
Solo gyn
Keene, NH USA
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