Pain Management (PM)
ACUTE PAIN MANAGEMENT WITH PARENTERAL (IV, IM, SC, INTRATHECAL, INTRADERMAL) IN A MEDICAL/NON TRAUMATIC ADULT PATIENT
This is the process of identifying and managing acute non-traumatic/medical pain by the nurse using parenteral medications and non-pharmacological measures to relieve pain.
Purpose
- Assess level of pain in patient
- Relieve the patient of pain, discomfort and suffering
- Promote the dignity of the patient
- Promote early ambulation and discharge of patient
- Prevent acute pain from progressing to chronic
- Prevent complications such as shock, death etc.
- Reduce pain with minimal adverse effect
Indications
- Patient experiencing pain requiring management
Equipment
- Patient’s folder (electronic or manual)
- Pain assessment tools: numerical scale and facial scale
- Sharp box
- Vital signs tray
- Medication tray
- A tray containing the following
- Prescribed parental pain medication and other adjuvant medications
- Syringes
- Needles
- Cotton wool swabs in a gallipot
- A bottle of methylated spirit
- Treatment chart (Electronic or Manual)
- Intravenous set
Procedure steps
- Establish rapport and explain pain management strategies to the patient
- Perform the five moments of hand hygiene
- Assess the level of pain using appropriate pain assessment tool based on the level of literacy of the patient
- Reassure patient of prompt pain management
- Show empathy to the patient
- Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
- Assess baseline vital signs: Temperature, Pulse, Respiration, Blood pressure and Oxygen saturation
- Prepare and send tray to the bedside of the patient
- Observe for the rights of medication administration
- Assemble syringe and needle using aseptic technique
- File/ break/hang pain medication depending on the type
- Draw medication with a syringe as per the prescription and discard the needle in a sharp box
- Replace needle with a new one and expel air
- IV or IM are administered as follows:
- Intravenous- remove needle and administer the drug into the venous access for the patient OR
- Intramuscular- assist patient into a required position and clean injection site with alcohol swab. Inject analgesic following standard protocol
Precautions
- Pain assessment is part of vital signs
- Provide patient and family with adequate information and education on pain management
- Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
- Treat each patient as an individual and involve the patient and family in the pain management
- Employ evidence-based contemporary recommendations for pain management such as:
- Pre-emptive analgesia (analgesic given before a painful stimulus)
- Multi-modal analgesia (using two or more forms of analgesic concurrently)
- Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
- Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
Open Component Task app