The Fifth Vital Sign

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Nurses Streamline Pain Management

by Jennifer Walker

IOm Recommendation 7When she was 16 years old, Nicklaine Paul, BSN, RN, woke up one night with excruciating pain in her lower back and legs. Growing up with sickle cell disease, she was familiar with the condition’s side effects. But this pain was more intense, like a “storm of daggers on your bones.” Paul’s family rushed her to the emergency room, where she sat in a wheelchair, screaming for three-and-a-half hours. “It was just unbearable. We have to do better [for our sickle cell patients],” says Paul, who is now a nurse in the Sickle Cell Infusion Center at Johns Hopkins.

Throughout health specialties, pain is the first symptom that drives people to seek services, says Suzanne Nesbit, PharmD, CPE, clinical pharmacy specialist and pain management research associate in the Department of Oncology at The Johns Hopkins Hospital. “We have to build a pain management infrastructure in our system to provide good patient care.”

Once a sickle-cell-disease patient herself, Nicklaine Paul, RN, now helps manage pain for patients in the Sickle Cell Infusion Center.

To streamline the hospital’s pain management response, Nesbit chairs the multidisciplinary Pain Management Taskforce. The 35-member group meets monthly to maintain and update pain policy, review reported patient safety events, and recommend improvements in care related to pain management.

The group’s biggest challenge is addressing the stigma that patients and providers associate with pain management, says Bobbie Norris, BSN, CNRN, BC-PRN, a Committee member and pain resource nurse in the Neurosurgery Pain Research Institute. “Patients are afraid they are going to become addicted, and providers are afraid we are going to overmedicate the patient,” she says. “We need to come to a happy medium.”

That’s where nurses come in. “Nurses are the clinicians who are spending the most time with patients,” says Lynn Billing, RN, CHPN, BC, a Committee member and nurse coordinator with the Duffey Pain and Palliative Care Program. They are in the best position, she continues, to communicate patients’ needs and advocate for effective pain management.

On the unit, nurses like Paul work in multidisciplinary teams to employ pain management techniques like IV narcotics, long-acting pain medications, and chronic blood transfusion therapy.

But first and most important, nurses must thoroughly assess each patient’s pain. “Pain is the fifth vital sign,” says Committee member Rick Ramos, BSN, RN, nurse educator in the Department of Medicine. “You really need to dig deep and almost be a detective to understand where the pain is and what it feels like,” Billing adds.

To assist with pain management assessment, the Pain Management Taskforce is developing nurse-pharmacist resource teams in each department.

Norris, the nurse leader on the pilot team in the Neurosurgery Pain Research Institute, remembers working with a soldier who lost his right arm and left eye after a bomb detonated in Afghanistan. He likely had not received enough opioid medication at other institutions. But after his surgery at Hopkins, the teary-eyed soldier said he felt better than he had on any other day since the accident.

“When you treat someone’s pain adequately and to their satisfaction,” Norris says, “the results you get are
really remarkable.”

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