Creating Better Pain Management through Clinical SimulationHollie AdejumoHoward High School

What is Pain?

An "unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.“-The International Association for the Study of Pain

http://health.howstuffworks.com/diseases-conditions/pain/nerve

Types of PainAcute or Transient painChronic or Persistent PainCancer Pain

http://health.howstuffworks.com/diseases-conditions/headache/10-types-of-headaches.htm

Methods of Managing Pain• Internal

Procedures• Medication• Therapy• Alternative

Therapies• Counseling and

SupportAcupuncture is a common alternative method for relieving pain

http://health.howstuffworks.com/wellness/natural-medicine/chinese/acupuncture.htm

Measuring Pain“Pain is whatever the experiencing patient says it is,

existing when she/he says it does” –McCaffery and Pasero (1999)

Patient’s Perspective:◦Demands physical, emotional, and mental

energyProvider’s Perspective:

◦Assessed by looking at a patient’s report, not the predicted signs and symptoms

◦Patients tells if pain is present and what it is like

◦ It is the healthcare provider’s job is to listen

Types of Pain MedicationNon-Opioid AnalgesicsOpioid Analgesics

Effective Pain Management

Combine opioid and non-opioid pharmaceuticals

Timely administration

http://www.wllc.com/blog/preventing-medication-errors.cfm

Patient ConcernsPsychological DependenceDrug TolerancePhysical DependenceAddiction

Effective Pain Management and ConsiderationsUnderstand a patient’s cultural

differences in pain expression◦Different cultures may have different

ideas of the meaning of painAssess the meaning of pain to a

patient

Pain Assessment ToolsOPQRSTUPain Scales

http://savvypatient.org

OPQRSTU of Pain AssessmentO nsetP rovocative/Palliative Factors

Q uality (Open Ended Questions)

R egion/RadiationS everityT imingU You

“How does pain affect you?”

Pain ScalesNumerical RatingWong-BakerVerbal RatingObserver Scales

Numerical Rating Scale

http://understandingpain.wordpress.com/category/pain-assessment-tools/

Wong-Baker Scale

http://understandingpain.wordpress.com/category/pain-assessment-tools/

Verbal Rating Scale- McGill Pain Questionnaire

http://pain.about.com/od/testingdiagnosis/ig/pain-scales/McGill-Pain-Scale.htm

Observer Pain Scales

http://0.tqn.com/d/pain/1/0/V/-/-/-/FLACC.gif

Using Pain Scales to Make Decisions about Pain Medication

Pain Scales make the pain measurable

Helps to determine if pain is mild, moderate, or severe

Makes it easier to find an effective dose

Factors Considered when Determining Medication Dosage• History of a patient’s pain• Pain intensity• Duration of Pain• Aggravating and Relieving

Conditions• Determine the cause of the pain

Clinical Simulation-Based Training“Simulation is a technique – not a

technology – to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” – David M. Gaba, Stanford University

Examples:◦ Standardized Patients◦ Mannequins◦ Computer-Based Simulation

http://blog.hospitalclinic.org/en/2009/05/nou-laboratori-de-simulacio-clinica-de-la-facultat-de-medicina/

Used to build a safer health system by providing guided practice

Benefits of Clinical Simulation

• Provides a variety of real-life situations• Opportunity to repeatedly practice

without real patients• Convenient• Active learning and Concentration• Increases collaboration within medical

teams

http://www.temple.edu/ics/programs/medicine/fy2.html

Standardized Patient• An actor trained to portray the

role of a patient, family member, or another individual• Simulate in a standardized

manner

http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index.html

http://www.temple.edu/ics/about/standardized.html

Resident Problems with Opioid Decision MakingLack of ConfidencePoor Interviewing TechniqueLack of Opioid KnowledgePoor written orders for

medicationInconsistent use of drug

calculations to determine drug doses

Improving Opioid Decision Making with Clinical Simulation-Based Training

Goals:◦To improve physician confidence

when working with a patient experiencing pain

◦To use drug calculations when making opioid decisions

◦ To write appropriate orders

http://zotzine.uci.edu/2009_04/patient.php

Assessing a Patient with Pain• Describe the Pain Scale

Appropriately• Ask patient of history of addiction• Discuss addiction vs. dependence• Ask about opioid related side effects• Assess for constipation• Address the fear of addiction• Make correct doses

Results

More comfortable with making dosage decisionsIncrease in confidenceMore frequent use of opioid

conversionsNot much effect on writing

appropriate orders

http://blog.soliant.com/doctor-and-physician-salary-ranges-average-salaries-and-educational-requirements/

Improving Results in the FutureContinuous education and

regular review will continue to improve resident physician skills

http://www.thedoctorweighsin.com/%E2%80%9Ctake-this-medication-okay-taking-a-look-at-emergency-department-discharge-instructions/

AcknowledgementsI would like to thank Ms. Emily

Shaw, Ms. Kat Walker, and all of the other staff at the Simulation Center for helping to make this project possible