Re: ACOG Antepartum Record - Pain Scale?
From: Charlie Chambers (cchamber@embarqmail.com)
Sat Nov 24 12:14:14 2007
Ooh, I like that one.
On Nov 23, 2007, at 1:23 PM, art fougner, md wrote:
> I can say unequivocally that the care given the chart is far superior
> than it has ever been. The care given the patient may be another
> matter
> entirely.
>
> Art
>
> At Fri, 23 Nov 2007, Joanne Bulley, MD wrote:
>>
>> I just had a vag hyst patient who the nurses gave vicodin to on an
>> empty
>> stomach in the PACU rather than the IV meds they usually use in the
>> recovery area (because she runs a low normal BP from being a body
>> builder). So then she was nauseous from the vicodin and got IV
>> compazine - then more vicodin & IV compazine on teh floor (instead of
>> just the IV Toradol). Her -EXPERIENCED- night nurse came on and
>> really
>> talked with her about what things were bothering her - and got rid of
>> the compazine and vicodin - and she was fine with just toradol and
>> then
>> motrin. Was home 24 hours after hyst.
>>
>> But the first nurses paying attention to the "pain scale" etc
>> didn't pay
>> enough attention to THE PATIENT ... and actually over medicated her
>> then had to give other meds due to that.
>>
>> While there are many things that ARE better about medicine and
>> care we
>> can give due to what we have learned in the 26 years since I
>> graduated
>> from med school ... there are these things that started out with
>> good
>> intentions (not leaving people in pain unnecessarily) there is a
>> lot of
>> dumb paperwork that has accompanied it.
>>
>> Joanne
>>
>> At Thu, 22 Nov 2007, Henry Gregor wrote:
>>>
>>> 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.
>>>
>> --
>> Joanne Bulley, MD, FACOG
>> Solo gyn
>> Keene, NH USA
>>
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
************************************************************************
*
Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"No matter where you go...
there you are."
Dr. Buckaroo Banzai
************************************************************************
