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