The fifth vital sign

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Pain has been accepted as a part of life since the beginning of time. “Still, health care doesn’t tend to manage pain well according to the research,” says Lorraine Bird, pain management project coordinator at The Credit Valley Hospital (CVH). Pain assessment needs to be as important as a patient’s temperature, heart rate, blood pressure, and respiratory rate. It has been referred to as the fifth vital sign because it is such an important indicator of well being.

Pain management is an integral part of the provision of care for patients in every health-care institution. Unrelieved pain interferes with mobility, sleep, eating, concentration and social interactions causing anxiety and distress, resulting in health implications. Recognizing that pain is under-managed and that more can be done to identify new medications and strategies to provide relief, CVH went beyond traditional care strategies designating resources to evaluate what they are already doing very well and to explore what more can be done in this area of care to achieve excellent pain management for patients.

With the support of senior management, a pain management coordinator has been dedicated to develop a work plan to identify, assess, and better address pain management strategies within CVH. Lorraine Bird, RN BScN, a nurse leader who has a keen interest in the area of pain management leads the project, which works in cooperation with the hospital-wide pain management steering committee to develop a vision for pain management at CVH.

It is the senior management support combined with the representation of every program and discipline on the hospital-wide steering committee that makes the difference in Credit Valley’s approach to this plan. The strong foundation upon which this program is being built would not be possible without the support and enthusiasm of the multi-disciplinary partners at the table. In addition the hospital’s physicians represented by the medical advisory committee are also supportive of the initiative uniting the entire health-care team toward a common goal.

“Pain is a symptom that often brings us to the hospital and it is an inevitable part of the healing process associated with a surgical procedure or hospital stay,” Bird says. “The stress of pain can affect the body’s healing ability and unrelieved pain may ultimately lead to a longer length of stay for the patient. It is therefore, in the best interest of the patient and the health-care system as a whole to address pain in order to decrease the psychological and physiological impact of pain for patients.”

Pain is subjective in that it is perceived differently by each individual. Each patient may require different medications and techniques to assist with their pain management. The key is to work together to find an approach that works best for the patient.

Evidenced based practice supports the medical management of pain. Credit Valley’s goal is to support these best practices with a multi-disciplinary approach with the patient at the center of care.

Through patient education and the encouragement of open communication with their caregivers, the patient may be better able to participate in the identification and pursuit of healing practices using complementary therapies to better manage and relieve their pain. Alternatives may include such things as massage, acupuncture, music therapy, a social worker, or spiritual care support that can provide many different techniques and strategies to relieve pain.

One key initiative employed at CVH is that of ongoing staff education. Several events generating awareness around pain management have been offered at rounds and through other vehicles including a very popular and inviting Pain Management Knowledge Café, which offered staff an entire ‘menu’ of strategies around pain management. These events have brought the various disciplines together in a meaningful way with the goal of having a significant impact on knowledge of pain management.