Long Term Care Training: Brace Your Pain Management Program


Read these questions with expert answers to ensure a systematic and fool-proof pain management program in your facility.

What do you do about a resident who doesn’t act like he's in pain but ask for pain medication every time the PRN med is due?

Answer: This falls into the category of course of a resident who is sometimes going to be looked at as somebody with drug seeking behavior or attention getting behavior. And the really important thing to do is to conduct a really thorough assessment and find out what's going on with him. He may be somebody who's stoic and really doesn’t want to show his pain.

And so, sitting down with him and saying, “You know, I noticed that every four hours or six hours or whatever, you need your pain medication. Maybe there is something better that we can do for you to give you more consistent comfort. So let's talk about your pain.” And see what you can find out.

And get the time together and figure out what you can do to help this gentleman. Now, the other piece of that is and this question always comes up, “What happens if it actually is drug seeking behavior?”

And certainly, a rare occasion that happens. And that is something that needs to be discussed with the physician. And the physician probably would want to involve the resident at some point in that discussion.

Question: The latest theory is that pain medication should be ordered to be given on routine basis. But if most of your residents are short-term rehab patients, does that make sense?

Answer: This is something that you might run into a lot. A person let's say had hip surgery and comes into the facility and he has PRN pain medication orders. And that's what we've always been used to. Whereas somebody let's say who has arthritis and has chronic pain from the arthritis, we may have him hopefully via constant pain, we have him on a routine arthritis medication maybe with another PRN med for breakthrough pain.

The key here is that what we're doing with this post-op patient who is on PRN pain medication is we're waiting for him to spike the pain level before we give him something for it. And that is not a nice thing to do. So the standard of practice is now and has been for a while. Anybody who has pretty consistent pain needs to be on a routine pain medication so that the pain level doesn’t spike.

The key is to stay ahead of the pain. Don’t let it spike so it doesn’t get so bad that the pain medication that's been decided on can't really do its job. So the answer to the question is the routine pain medication for short-term rehab patients does make sense for residents who have pretty much constant pain as per the long term care guidelines.

Question: Considering the goals for pain management, should you be shooting for eliminating pain for everyone?

Answer: For most people, we need to have zero on the scale of zero to ten. But the fact is for some people, to get them to a zero might not even be possible for one thing.

And for some people, it might be possible. But in order to do that, we’d be putting them to sleep. Or if we're not putting them to sleep. Or if we're not putting them to sleep, we're making them unsafe by giving them narcotics or some medication that makes them unsteady on their seats. It might decrease their appetite. And so it affects their nutritional status. All of these things have to be taken into consideration.

Long Term Care Training Tip: So a really important thing is to assess what's an acceptable level of pain for the resident. And if you have somebody who's really stoic, he might say “Oh, I don’t want any pain medicine at all.” But then, you know, you observe him and you see that let's say he had hip surgery and he's laying in bed and he won't move because he knows that if he moves, he's going to be in severe pain from that hip. Well, you know, that's not good for him neither.

So that's where the negotiation takes place. And you sit down with him. And you say, you know, get him to move somehow just during the discussion and you observe his pain, you bring it up, you discuss it with him. Educate him about, you know, “You're not going to become addicted” or whatever his particular issue is. And then, you know, work towards figuring out what a reasonable goal is if zero isn't really going to be the goal for him.


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