Re: ACOG Antepartum Record - Pain Scale?
From: art fougner, md (evsono@pipeline.com)
Fri Nov 23 14:20:56 2007
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
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