Pain is a subjective experience that affects patients both physically and emotionally; therefore, it is critical to consider it as more than just medication management. Pain is the fifth vital sign and proper assessment is key. In our continuing series on pain management we will address the interdisciplinary approach that should be implemented for proper pain assessment.
During the initial assessment, a history of pain experiences should be determined. The patient should be asked to describe previous and any current pain experiences, including:
- Effectiveness of the methods used to manage the pain, both pharmacologic and non- pharmacologic.
- Experiences with side effects and/or interactions.
- Typical coping responses while having pain and what is most effective.
- What, if any, concerns that they may have that could affect their willingness to report pain and use of analgesics. If there are issues, identify ways they could be overcome.
Assessing pain is an ongoing process that must be completed during every home visit. Aides do not conduct a pain assessment, but instead will note anything the patient tells them about the pain and report the information to the appropriate clinicians on the pain management team. However, pain assessments should be completed by the other members of the team who were discussed in our first blog in this series. The assessment needs to be very detailed and address the following areas:
- Pain characteristics such as onset, duration, location, quality, and intensity,
- Specific pain location(s),
- Associated symptoms,
- Factors that help to alleviate or exacerbate pain,
- Functional abilities – with and without pain, and
- PRN medication issues.
Improving OASIS M1242 Outcome
The OASIS M1242 outcome focuses on improving the frequency of pain interfering with the patient’s activity or movement. The guidelines and intent of this outcome cover several different areas. It deals with activities of daily living (ADLs), which include eating, bathing, dressing, transferring, etc. However, this outcome also deals with instrumental activities of daily living (IADLs), which are related to independent living and include preparing meals, shopping for groceries, etc. Both types of activities must be evaluated because they can provide additional information about how the frequency of pain is impacting a person and what treatment modalities may be needed. It is also important to not overlook a decrease in ADL or IADL function due to pain, such as a patient reporting that he or she sits in the chair all day and puts off going to the bathroom because it hurts so much to get up from the chair or to walk. Watching the patient perform tasks in addition to asking can help identify functional ability and pain.
The intent of M1242 is to also assess at how pain interferes in activities that are not a part of normal ADLs and IADLs, which include sleeping, watching TV and even recreational activities such as playing cards. Pain interferes with activity when pain results in:
- Activity being performed less often than otherwise desired,
- Requires the person to have additional assistance in performing the activity, or
- Causes the activity to take longer to complete.
Let us Guide You with Proper Pain Assessment
Assessing pain can be quite complicated, but our team at 5 Star Consultants can help. We can put our years of experience to work for your team to ensure that they fully understand pain management, from how to build your interdisciplinary team to assessing and documenting a patient’s pain correctly. We offer onsite training as well as webinars to address this critical topic. For further information, please feel free to contact us at [email protected] or 866-428-4040.