presented by Cathleen Armato
Thorough pain assessments are a critical component of adequate pain management. Clinicians will learn how to conduct a verbal, physical, and functional pain assessment, barriers to pain management, population groups at risk of under-treatment, harmful effects of unrelieved pain, and goals of pain management.
Cat Armato is an experienced executive with 18 years in the home care and hospice industry. She has served in various roles during that time, including VP of Operations and Chief Compliance Officer for a nationwide provider. In 2012, Cat became a consultant and has assisted multiple organizations with their compliance and quality efforts, from program assessment to full program development and implementation. Cat has served as a compliance consultant for a large organization under a Corporate Integrity Agreement. This multi-year, multi-site project involved assessments of operations, quality of care, and clinical documentation. She has also provided clinical and claim reviews for more than 1,200 records of various providers, many with multiple billing periods. Cat has experience providing guidance and support to providers and their legal counsel during investigations by Zone Program Integrity Contractors, Specialty Medical Review Contractors, Medicaid Integrity Contractors, Medicare Administrative Contractors, and investigations with the Department of Justice and the Office of the Inspector General. She also has extensive experience in due diligence evaluations. Cat is a contributor/reviewer for multiple health care publications by Tina Marrelli, including: Home Care Nursing © 2017, Handbook of Home Care Standards © 2018, Hospice and Palliative Care Handbook © 2018, and A Guide for Caregiving © 2017. She also served as assistant author for The Nurse Managers Survival Guide: Practical Answers to Everyday Questions by Tina Marrelli.
This chapter discusses the definition of pain and barriers to effective pain management. Patient/family perceptions and healthcare providers and systems can all contribute to inadequate pain management. Additionally, certain populations are at increased risk of under-treatment of pain. The psychological and physiological responses to under-treatment will be discussed.
This chapter discusses neuropathic, somatic, and visceral pain. Each pain type will be examined to assist the clinician in determining the etiology of the patient’s pain. Knowing the etiology contributes to effective pain management as different types of pain are managed differently.
Although many clinicians are consistent in asking the patient for their current pain level, this is only one small portion of a complete pain assessment. This chapter reviews seven components of a thorough verbal pain assessment and the rationale for gathering the information. With the correct information, the clinician will be able to assist the patient and advocate for a pain management protocol to meet patient goals.
This chapter demonstrates an effective verbal pain assessment. This demonstration follows the guidance outlined in the previous chapter. This will give the clinician an example of how to best gather complete information.
The physical and functional portion of a thorough pain assessment is the hands-on component. This chapter will provide guidance as well as tips to prevent misinterpretations of findings.
Based on the information obtained during the assessment, the clinician will communicate with the physician, providing relevant and concise information. Other services and assistive devices will be reviewed. Finally, the clinician will work with the patient to develop a care plan with patient-specific goals. This chapter reviews each of these steps and how they contribute to an effective pain management protocol.