Pain Assessment: A Human Right

The right of every patient to appropriate pain assessment and management and therapy implications.

Presenter: Alys H. Nawawi, MS PTLead Therapist

Inpatient Physical TherapyGSPP at Penn Presbyterian Medical Center

Believe a patient’s report of pain

Objectives

• Review therapy Codes of Ethics• Discuss concepts of beneficence and non-

malfeasance• Review three pain assessment scales to

address the varying needs of patients• Appreciate the multiple reasons for pain

assessment • Discuss implications for therapy practice

and intervention

Food for thought

“No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, … any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee. “

John Donne Meditation XVII

Devotions Upon Emergent Occasions

Goal

To act in a manner informed by an appreciation of the humanity and rights of the patients for whom we

care

OT Code of Ethics:

Principle 1. Occupational therapy personnel shall demonstrate a concern for the safety andwell-being of the recipients of their services.

(BENEFICENCE)

Principle 2. Occupational therapy personnel shall take measures to ensure a recipient’s

safety and avoid imposing or inflicting harm. (NONMALEFICENCE)

Speech Language Pathology Code of Ethics

Principles of Ethics II.

(1) A licensee shall hold paramount the welfare of persons served professionally.

(v) A licensee shall take all reasonable precautions to avoid injuring a person in the delivery of professional services.

PT Code of Ethics

PRINCIPLE 1:

A physical therapist shall respect the rights and dignity of all individuals and shall provide compassionate care

Position statement with Clinical Practice Recommendations of the

American Society of Pain Management Nursing:

“ Providing quality and comparable care to individuals who cannot report their pain is directed by the principle of justice ( the equal or comparative treatment of individuals). “

PPMC Mission Statement

Penn Presbyterian Medical Center

( PPMC ) is committed to providing extraordinary community health care to the

Philadelphia Region , while supporting Penn Medicine excellence through

education and research

Joint Commission Chapters

• Patient Rights

• Provision of Care

• Patient Education

Joint Commission

“Listed as the most feared symptom of illness and disease, the perception and description of pain is highly individualized. As healthcare clinicians, it is our job to reduce the pain to a functional level. Including the patient in the process through education about pain, pharmacological and non-pharmacological treatments helps the patient to understand that there is much that can be done to reduce, if not eliminate, pain.”

Pain Assessment• Intensity• Location • When: Before, During and After• Willingness to proceed• Description

– Possible neuropathic: sharp, stabbing, shooting, burning– Possible somatic/visceral: throbbing, dull, aching, cramping

• Duration• Alleviate/ Exacerbate:

– with movement– At rest– unprovoked

• Intervention (s)

Hierarchy of Pain Assessment Techniques

(McCaffery and Pasero, 1999) A. Self Report B. Search for Potential Causes of Pain: A

change in behaviour requires careful evaluation of the possibility of additional sources of pain.

C. Observe Patient Behaviours: In the absence of self report, observation of patient behaviouris a valid approach to pain assessment. Not always accurate reflections of intensity and may indicate another source of distress

D. Surrogate Reporting

Pain Scales and Assessment Tools

1. 0-10 scale: No pain to worst imaginable

2. Wong-Baker FACES Rating Scale

3. FLACC Scale: Developed for use with children, now for use with non-verbal patients

0-10 Scale

Wong-Baker FACES Scale

IssuesSome patients have difficulty using

Not good for non verbal patients

Some patients will rate higher than 10:

Credit :http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html

Issues : Continued

Language Barriers: Resources

http://uphsxnet.uphs.upenn.edu/PPMCpain/

Has scales in 20 languages: Examples follow

German

Italian

Spanish

Vietnamese

French

Chinese

FLACC

Why assess:

Beyond Codes of EthicsBeyond regulatory requirements

• Determine ability to participate• Ensure safety• Diagnose• Monitor progress• Intervention modification• Pain control/modification

It is more than accreditation

Believe a patient’s report of pain