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Re: ACOG Antepartum Record - Pain Scale?From: Henry Gregor (henrygregor@yahoo.com)Thu Nov 22 22:35:20 2007
Well said Charlie. FWIW,I just had an overnite stay after a lumbar diskectomy. Attention to pain assessments was meticulous, to the point of being disruptive to comfort at some times when the scheduled patient charting assessment was required. OTOH, if a perceived need for analgesics occurred "off schedule" the response was highly variable, driven somewhat, I believe, to staff involvement accomplishing charting requirements and programmed asessments on the group of us patients...certainly not from unconcerned or unprofessional staff, who were outstanding, but their burdens are many, and can't be ignored if they wish to keep their positions. Also from my longstanding prior viewpoint "comfortable" is not a useful answer to staff, as they must have that number to record. Not their fault of course, and certainly well trained and experienced nurses and physicians can process the meaning of a "comfortable" reply....but trees must be felled, paper entries made, binary code electronic records must follow, and who cares how many current forms or emr's must be revised/reprinted/reprogrammed to meet compliance. Hank .."comfortable" was not an acceptable answer, and to persist with Charlie Chambers <cchamber@embarqmail.com> wrote: Pain is not a vital sign. It's a symptom. The key is what is the cause, not to go to endless lengths to document the symptom. No one ever died or suffered sequelae from pain alone. I have issues with our current society believing that everything should be painless. No, I don't think people should suffer needlessly, but the idea that we should be able to treat all pain till absent seems hopeless. Plus, it just contributes to all the oxycontin, methadone, etc addiction that exists. On Nov 21, 2007, at 8:34 AM, ainsron wrote: It also reflects the recommendation/requirement of the nursing and medical boards of California that pain be assessed on any patient whose vital signs are recorded: "It is now required that all health care staff record pain assessment each time that vital signs are recorded for each patient. If the institution is using the zero to ten pain assessment scale, a recording of pain 2/10, fulfills the requirements of this law. The Board reminds RNs that pain assessment is based on patient self-report and that patient's can be asleep and still experience significant pain; appropriate charting would be to write "asleep" for the pain rating. Registered nurses will continue to be required to monitor all five vital signs and take appropriate action based on deviations from normal. In other words, a competent registered nurse intervenes when the patient's pain is not being managed according to the agreed upon comfort level." Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron Sent: Wednesday, November 21, 2007 8:26 AM To: Multiple recipients of list OB-GYN-L Subject: RE: ACOG Antepartum Record - Pain Scale? It probably reflects JCAHO's position that pain is the "fifth vital sign." Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Don Miller Sent: Wednesday, November 21, 2007 6:31 AM To: Multiple recipients of list OB-GYN-L Subject: ACOG Antepartum Record - Pain Scale? Just took a look at the latest ACOG Antepartum record and noticed that they slipped in a new column in the obstetric flowsheet for "Pain Scale". Considering that things that ACOG publishes tend to be held up as a standards of care (especially by lawyers), I'm wondering where this item came from. Where is the overwhelming evidence of benefit to the patient or a multitude of references to elevate such an item to suggest routine documentation at every prenatal visit? I've done a cursory look through PubMed and the ACOG website and haven't found anything. If there is such data, could someone please illuminate me as to the value of this new column and the proper response to patients who repeatedly say they have pain? What are the next diagnostic steps to defend oneself when a patient reports and you document continual pain? OR, is this designed to be defensive legal strategy to counteract patients with bad outcomes who said they were always in pain and there was no documentation of such (or the absence of pain)? My worst fear is that this was a pet project or self-serving agenda lobbied by someone on the committee that creates the form and is not evidence-based and adds one more task, one more question.. This is in the face of real evidence that suggests that urine dipstick testing for sugar and protein provides no benefit and probably should be dropped from routine prenatal care and from all prenatal forms. So, what's the story? -- Donald W. Miller, Jr., MD, FACOG eNATAL, LLC http://www.eNATAL.com **************************************************************************** Charlie Chambers Hood River, OR -- cchamber@alumni.rice.edu
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