Case Study Jimmy Jones

We Know Your Pain!!!

Jimmy Jones is a 56-year-old patient who is admitted to your unit with a s/p abdominal surgery. In assessing his pain level, Mr. Jones complains a 6 out of 10 pain. When the nurse looks into the physician’s order, there are several pain medications to choose from in the patient’s medical administration record (MAR). The pain medications that are ordered are listed as follows:

• Tylenol 650 mg PO q 6 hours prn mild pain or temp greater than 100.4

• Motrin 600 mg PO q 8 hours prn mild pain

• Norco 1-2 tabs PO q 4 hours prn pain ranges 4 to 8 out of 10

• Dilaudid 2 mg IV q 6-8 hours prn severe pain

Isn't it a "painful dilemma" to determine which pain medication should be administered to Mr. Jones?

YES! WE KNOW YOUR PAIN!!!

Therefore, ARMC has decided on a standardized pain assessment scales and four pain categories to rate our patient’s pain. ARMC's accepted pain categories are: No pain (0), Mild pain (1-3), Moderate Pain (4-6) and Severe Pain (7-10). Moving forward, we will be changing our pain badge card (See pictures) to mirror the current pain category and approved pain scales:

During the last Physician and Nurse Collaboration meeting, nurses and physicians discussed and collaborated on the following practices:
• Avoiding overlapping of pain category (i.e. Tylenol for pain 1-6 and Vicodin for pain 4-8)
• Avoiding ranges on drug dosage and/or time (i.e. Norco 1-2 tabs q 4-6 hours prn severe pain)
• Limiting to 1 pain medication to 1 pain category (i.e. Tylenol 650 mg PO or Motrin 600mg PO for mild pain)
• No partial dosage given (If the physician orders Norco 2 tabs for pain but patient only requests to have 1 tab, please call the physician to change to 1 tablet or write a 1x order)
• Administer pain medication per physician order only (If Dilaudid is ordered for severe pain, do not give Dilaudid for any other pain category(ies))
• Refraining from using pain scales interchangeably (When patient is sleeping, document patient is ASLEEP. Do not use FLACC scale just because the patient is sleeping)

When encountering any of these "painful dilemmas" as listed above, please clarify any concerns with the ordering physician. For specialty units, continue to follow the unit-specific policy and practices.
References: AOM 620.05 Pain Assessments and Management

Author: Debbie Ho, RN and Mary Keungmanivong, RN 9/2016