Clinical Pathway for Collaborative Care: Acute Pain Management

 

 

Via Christi Regional Medical Center-St. Francis Campus

Wichita, KS

 

 

Developed by:

Shirley Otto, RN, MSN, CRNI, ADCN

Susan K. Duncan, RN, MS

Larry N. Baker, APR


ST. FRANCIS REGIONAL MEDICAL CENTER

WICHITA, KANSAS

Clinical Pathway for Collaborative Care

Acute Pain Management

 

General and Pre-operative/Procedure Data

Patient Name:   Hospital Number:   Date of Birth:  
Date of Admission:   Time of Admission:   Attending Physician:  
Patient Weight:   Patient diagnosis:  
Surgical intervention/procedure:   MD performing procedure:  
Has a comprehensive pain assessment been conducted and documented? o Yes o No  
Has a medical/nursing pain management plan been developed and communicated? o Yes o No  
Does the patient communicate relieved and unrelieved pain? o Yes o No  
Total time in minutes from arrival in nursing unit in acute pain to maximum pain control (0-3 range)?  
Total time in minutes from arriving in pain at Admissions/Emergency Services to maximum pain control (0-3 range)?  
Total time in minutes from initial order to administration of first dose?   First dose of analgesia  
(drug, dose, time)

Therapy Options (see Physician’s Guide for dosing data)

o NSAIDS o PCA

o Opioids o Nonpharmacological interventions

o Local anesthetics

o Epidural

Indications for Epidural Analgesia* -- evaluated daily

o Orthopedic procedures

o Urological procedures

o Gynecological procedures

o Upper Abdominal procedures

o Thoracic procedures

o Trauma victims

o Chronic cancer pain (not relieved by opioids)

Important parameters of assessment with narcotics

o Respiratory rate q hr for 12 hrs then q 4 hrs

o Sedation rate

Important parameters of assessment with local anesthetics

o Vital signs q 4 hrs

o Sensory level & degree of motor block

Other important precautions

o no additional opioids or CNS depressants**

**See Pharmacy listing of CNS depressants

o patient should not ambulate without assistance

* Only Anesthesiologist may insert/prescribe medications for Epidural Analgesia (See Physician Guidelines for Epidural Analgesia)

CHECK ALL THAT APPLY

 

 

 

Indications for PCA* -- evaluated daily

o patient requires parenteral narcotics for at least 24

o post-operative, trauma, burn patient with clear sensorium

o patient suffers from chronic pain

o patient with severe acute pain syndrome

o patient does not tolerate or other routes are unavailable

*See Physician Guidelines for dosage, rate, etc.

 

 

Discharge criteria met:

o Patient’s pain reduced or alleviated

o Patient’s personal preferences are met

o Patient demonstrates skills required to manage pain

o Patient states resources available to assist with pain concerns

 

 

 

 

See reverse side for patient, physician, and nurse interview questions.