Strategies to Enhance Patient Care and Compliance with Pain Order Duplications and Gaps

2021 ◽  
pp. 001857872110323
Author(s):  
Shayna Cruz ◽  
Amberene Daya ◽  
Andrea Quinn ◽  
Amanda Ries
Keyword(s):  
Pain Management ◽  
Patient Care ◽  
Visual Analog Scale ◽  
Patient Preferences ◽  
Joint Commission ◽  
Hospital Level ◽  
Analog Scale ◽  
Vas Scores ◽  
Enhance Patient Care ◽  
The Joint Commission

According to the Joint Commission every patient has a right to pain management. Due to multimodal pain management, pain orders have the potential for duplication as well as gaps in therapy. At our institution, we evaluated pain orders and implemented strategies that aimed to reduce those gaps. We found that current ordering practices permitted the use of varying visual analog scale (VAS) ranges (e.g., VAS 1-3 and 1-5) which inherently increased the potential for duplicate therapies. When gaps in therapy occurred, medication orders for corresponding VAS scores were not available and thus, therapy was delayed. Additionally, current administration policies did not take into account patient preferences for less potent agents which can also cause a delay in care. In summary, simple strategies, discussed in this article, may be implemented at the hospital level to optimize patient care while maintaining recommendations by the Joint Commission for clear medication orders.

An Audit of Pain Control Pathways following Video-Assisted Thoracoscopic Surgery

2011 ◽  
Vol 6 (4) ◽  
pp. 248-252 ◽  
Author(s):  
Espeed Khoshbin ◽  
Ali N. Al-Jilaihawi ◽  
Nicholas B. Scott ◽  
Dhruva Prakash ◽  
Alan J. B. Kirk
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Severe Pain ◽  
Thoracoscopic Surgery ◽  
Analog Scale ◽  
Pain Scores ◽  
Audit Commission ◽  
Video Assisted Thoracoscopic Surgery ◽  
Daily Pain

Objective To compare different modes of pain management following video-assisted thoracoscopic surgery (VATS) to our national standard. Methods This is an audit based on patient's experiences. One hundred consecutive patients who underwent VATS with or without pleurodesis were managed by one of the following pain relief pathways: (A) thoracic paravertebral block + morphine patient-controlled analgesia (PCA), (B) percutaneous thoracic paravertebral catheter +/– morphine PCA, (C) thoracic epidural +/– morphine PCA, (D) morphine PCA alone, and (E) intravenous or subcutaneous morphine as required. Pain score was documented up to four times per day for each patient. The incidence of severe pain was defined as visual analog scale ≥7. The results were compared with the standard set by the audit commission for postoperative pain relief in the UK. The mean daily pain scores were calculated retrospectively for all patients. Results There were no statistically significant differences in mean daily pain scores irrespective of having a pleurodesis. The percentage of patients experiencing severe pain was 34% [mean visual analog scale = 8 (standard deviation = 1.0)]. This was almost seven times the standard. Among these pathways, B had the least percentage incidence of severe pain (16.7%) followed by A (25.0%) D (33.3%), C (35.7%), and E (52.4%). Conclusions We are not compliant with the standards set by the audit commission. Pain management in theater recovery needs to be targeted. In the light of these results, we recommend the use of percutaneous thoracic paravertebral catheter +/– morphine PCA for postoperative VATS pain relief.

Posttraumatic Nasal Valve Collapse: Is Alar Batten Graft the Answer?

2016 ◽  
Vol 9 (3) ◽  
pp. 125-129
Author(s):  
Avinash Das
Keyword(s):  
Nasal Obstruction ◽  
Visual Analog Scale ◽  
Nasal Valve ◽  
Analog Scale ◽  
Interventional Study ◽  
Symptom Evaluation ◽  
Vas Scores ◽  
Nasal Valve Collapse

ABSTRACT Introduction Posttraumatic nasal valve collapse (NVC) is an underdiagnosed cause of nasal obstruction causing significant symptoms and has been treated by various techniques, the results of which have been variable. In our study, alar batten graft (ABG) has been used to strengthen the nasal wall. Techniques A prospective interventional study was done on 13 patients of posttraumatic NVC using an ABG to reinforce the ala, and results were measured on the basis of standardized nasal obstruction symptom evaluation (NOSE) and nasal obstruction visual analog scale (NO-VAS) scores at 6 months. Results There was a statistically significant improvement in 12 out of 13 patients, with mean improvement of 25.62 on NOSE and 2.4 on NO-VAS scores. There was a visible improvement in the extent of collapse also. Conclusion Posttraumatic NVC can be treated effectively using ABG, with significant improvement in standard scores as well as the symptomatology. How to cite this article Maggon NV, Sethi A, Das A. Posttraumatic Nasal Valve Collapse: Is Alar Batten Graft the Answer? Clin Rhinol An Int J 2016;9(3):125-129.

The Visual Analog Scale for Pain

2001 ◽  
Vol 95 (6) ◽  
pp. 1356-1361 ◽  
Author(s):  
Carol A. Bodian ◽  
Gordon Freedman ◽  
Sabera Hossain ◽  
James B. Eisenkraft ◽  
Yaakov Beilin
Keyword(s):  
Visual Analog Scale ◽  
Outcome Measure ◽  
Patient Controlled Analgesia ◽  
Analog Scale ◽  
Full Spectrum ◽  
Vas Score ◽  
Vas Scores ◽  
Relevant Outcome ◽  
Apparent Influence ◽  
Research Studies

Background The visual analog scale is widely used in research studies, but its connection with clinical experience outside the research setting and the best way to administer the VAS forms are not well established. This study defines changes in dosing of intravenous patient-controlled analgesia as a clinically relevant outcome and compares it with VAS measures of postoperative pain. Methods Visual analog scale measurements were obtained from 150 patients on the morning after intraabdominal surgery. On the same afternoon, 50 of the patients provided a VAS score on the same form used in the morning, 50 on a new form, and 50 were not asked for a second VAS measurement. Results Visual analog scale values and changes in value were similar for patients who were given a new VAS form in the afternoon and those who used the form that showed the morning value. The proportions of patients requesting additional analgesia were 4, 43, and 80%, corresponding to afternoon VAS scores of 30 or less, 31-70, and greater than 70, respectively. Change from morning VAS score had no apparent influence on patient-controlled analgesic dosing for patients with afternoon values of 30 or less or greater than 70, but changes in VAS scores of at least 10 did discriminate among patients whose afternoon values were between 31 and 70. Conclusions When pain is an outcome measure in research studies, grouping final VAS scores into a small number of categories provides greater clinical relevance for comparisons than using the full spectrum of measured values or changes in value. Seeing an earlier VAS form has no apparent influence on later values.

Sucrose for Neonatal Procedural Pain

2001 ◽  
Vol 20 (7) ◽  
pp. 63-67 ◽  
Author(s):  
Barbara Noerr
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Joint Commission ◽  
Procedural Pain ◽  
Healthcare Organizations ◽  
Neonatal Pain ◽  
Management Standards ◽  
Widespread Interest ◽  
The Joint Commission

EFFECTIVE JANUARY 1, 2001, ALL hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) must comply with newly approved pain management standards.1 Although such standards present us with an important opportunity to improve pain assessment and interventions for neonates, it is unfortunate that an accrediting body mandate provided the momentum for the now widespread interest in the management of neonatal pain.

Severity of Rhinosinusitis: Comparison Between Visual Analog Scale Given by Patients and Otorhinolaryngologists

2020 ◽  
Vol 34 (6) ◽  
pp. 734-741 ◽  
Author(s):  
Li Zhao ◽  
Ke Na Yu ◽  
Jian Li Tan ◽  
Hai Ling Zhang ◽  
Peng Jin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Visual Analog Scale ◽  
Revision Surgery ◽  
Nasal Polyps ◽  
Staging System ◽  
Position Paper ◽  
Moderate Correlation ◽  
Analog Scale ◽  
Significant Difference ◽  
Vas Scores

Background Visual Analog Scale (VAS) as determined by the patient is recommended by the European Position Paper on Rhinosinusitis and Nasal Polyps 2012 in evaluation of the total severity of the chronic rhinosinusitis (CRS) patients’ symptoms. Objective To evaluate the correlation between evaluations performed by otorhinolaryngologists and CRS patients with commonly used systems. Methods Scores of VAS and Sino-Nasal Outcome Test-20 (SNOT-20) Chinese version were obtained from 110 CRS patients with nasal polyps (CRSwNPs, n = 61) and without nasal polyps (CRSsNPs, n = 49) before surgery, which were compared with scores of Lund–Kennedy endoscopic staging system, the Lund–Mackay computed tomography (CT) staging system, and VAS from 3 attending otorhinolaryngologists. Results The median VAS scores given by CRS patients (6.0; 4.25–7.5) do not correlate significantly with the VAS scores by the 3 otorhinolaryngologists (5.5; 4.83–6.5) with a correlation coefficient of .218 (−0.146 to 0.466). For CRS patients, there was only a moderate correlation between scores of VAS and the SNOT-20 ( r = .37), and no significant difference of VAS scores between CRSwNP and CRSsNP, and between unilateral and bilateral nasal polys. For otorhinolaryngologists, a higher median VAS score was found in CRSwNP (6.0; 5.17–7.0), especially in bilateral (6.0; 5.0–7.08) and revision surgery (6.08; 5.33–7.63). The VAS scores of otorhinolaryngologists correlated significantly with the Lund–Mackay CT score ( r = .7536) and Lund–Kennedy endoscopic staging ( r = .5947). Conclusions VAS scores between patients and physicians are not correlated significantly in this study, but they fall within the same therapeutic range and do not change the clinical management of the patients.

scholarly journals Examining Knowledge of Pain Management

2020 ◽  
Author(s):  
Sunita Dutt
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Costs ◽  
Nursing Care ◽  
Joint Commission ◽  
Significant Burden ◽  
Increasing Knowledge ◽  
Care Costs ◽  
The Joint Commission

Pain places a significant burden on the society and individuals through health care costs, loss of productivity, and loss of income. A widening gap exists between increasing knowledge about pain and the application of this knowledge to treat pain. The Joint Commission (TJC) provides guidelines for nursing care of patients with pain. The purpose of this paper explore the application to practice of TJC guidelines for nursing care of the patients with pain.

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