Re: ACOG Antepartum Record - Pain Scale?
From: Charlie Chambers (cchamber@embarqmail.com)
Wed Nov 21 10:22:38 2007
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
>
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Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"Almost anything you do will seem insignificant but it is very important
that you do it....You must be the change you wish to see in the world"
-- Mahatma Ghandi.
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