Effectively managing patients’ pain
– Best Practice recommendations for hospitals
Gallup consultants have worked with more than 600 leading healthcare
providers around the
world to better understand how to effectively manage patients’ pain. Richard
Senior Practice Consultant, Gallup, reports.
Many healthcare professionals consider
pain management critical not only to a
patient’s recovery but also to his or her
positive engagement with a healthcare
facility. A healthcare provider’s ability to
understand and respond appropriately to
patients’ pain affects those patients’
overall experience with their care
provider. Hospitals should make sure that
there are policies in place that answer the
- What methods do we use to manage
- Do our patient-facing healthcare
professionals have a good understanding
of a patient’s personal or spiritual needs regarding pain management?
- What alternatives to medication do we
discuss with patients, and how do we
stay current in this area?
- How can we ensure that discharged
patients will be able to properly manage
In working with more than 600 leading
healthcare providers around the world on
patient engagement, safety, and experience,
Gallup has discovered that these are
best practices related to pain management:
Patient and staff interventions
- Set patient expectations appropriately.
Pain control doesn’t necessarily mean the absence of pain. Sometimes a
certain level of pain is necessary to
properly diagnose and treat a condition.
- Anticipate the pain medication
schedule. Don’t wait for patients to ask
for pain medication. Visit patients
before it is time for their next medication
to ask them their level of pain, and
be prepared to administer the next pain
- Stay in constant communication with
patients while trying to control their
pain. Ask yourself: “Have I done everything
I can to control this patient’s pain?”
You should also be aware of and treat
symptoms that might be associated with pain management. Different cultures
have differing tolerance of or willingness
to reveal pain. Cultural sensitivity
includes talking about pain with patients
and their family, being aware of differences
in sensitivity, and building a relationship
with patients to encourage them
to communicate about their pain.
- Understand that pain is emotional as
well as physical. Pain management
must address both the physical and
emotional symptoms of pain. For
example, a cancer patient is awake and
in pain during the night. Although she
is in physical pain, emotional distress is
keeping her awake. A good nurse will
sit beside the patient, hold her hand,
and say: “I understand.”
- Record current pain levels on a whiteboard.
Noting pain levels where
patients and staff can see them facilitates
staff communication and coordination.
In many hospitals, for example,
a whiteboard is placed at the foot of the
bed or on the wall where the patient
can view it and staff members have easy
access to it. Staff members update the
board with key information, such as the
nurse’s name and the patient’s pain
level at each round or check-in. Staff
members can use this information to
answer questions about the patient’s
pain levels when discussing treatment
options with the patient.
- Educate patients about how to manage
their pain after being discharged. One
hospital discovered that most patients
who called the hospital the day after
they were discharged reported that they
were in pain, even though the pain was
under control when they left the
facility. Further investigation revealed
that patients were failing to take their
pain medications as prescribed. Some
thought the prescription would be
expensive, so they tried to avoid the
expense and did not get the prescription
filled; others filled the prescription
but rationed their pain medication by
taking it when they felt they needed it
instead of according to schedule.
Because pain pills do not work immediately,
the delay in taking the medication
caused patients’ pain to increase
dramatically. Hospital staff used two tactics to help patients understand why
they needed to take their medication
on schedule after discharge. First, they
printed the warning: “If you do not take
your pain medicine, you will be in pain”
in bold at the top of the written
discharge instructions. Then, during
discharge, a staff member verbally
cautioned patients: “If you do not take
your pain medicine, you will be in
pain.” This may seem blunt, but
patients needed this message in
language that was easy to understand.
Staff and hospital interventions
- Initiate a pain-control policy.
Healthcare professionals must be
familiar with their hospital policies and
openly discuss pain control with
patients and their families. Consult
with patients about methods that have
– and have not – worked well in the
past. Patients also should have a chance
to voice their concerns about medications
and how to administer them.
When appropriate, healthcare professionals
should discuss their roles in
managing pain and the potential limitations
and side effects of treatment with
patients and their families.
- Review the process for pain medicine
delivery from the pharmacy to the
nursing unit. Pay particular attention to
off-shifts and weekends. Poor coordination
or the lack of timely delivery
between the pharmacy and the nursing
unit is a frequent cause of patient pain.
Both the nursing staff and the pharmacy
should look at communication
policies and procedures to ensure that
medication is available or delivered
promptly when patients need it. Many
hospitals have adopted Toyota’s “lean”
approach to quality management; this
review process could prompt a joint
lean project between the nursing staff
and the pharmacy.
- Educate all hands-on providers about
pain assessment and management.
Proper education for providers results in
a cohesive pain-management programme for patients.
- Become familiar with non-medication
pain control to provide patients with
“high-touch” pain management options. The American Nurses
Association (ANA) differentiates
between medication and non-medication
pain management. Teach patients
breathing exercises and the benefits of
massage, positioning, cold pack care, and
relaxation. All of these are high-touch
ways to provide patient-friendly care.
Pain is a major barrier to engaging
patients during their hospital stay and after
they are discharged. Following best practices
in pain management will result in
better clinical outcomes because patients
will be more engaged in their care and
more likely to follow instructions after
they leave your care.
Copyright © 2012 Gallup, Inc.
Published with permission from Gallup.
of upload: 22nd Jan 2013