I'm new here, just started paramedic classes a couple weeks ago and had a question for all the medics here regarding pain scale. We always learned 1-10 until now when the teacher says he will literally kick us if he hears us use that. He says now that we have pain meds at our disposal we are always shooting for a 0 because a 1 means some pain. So how do you guys ask your patients? Is it 1-10 or 0-10.
Pain scale?
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This sounds like some of the anal quirks some of the teachers I work with push on their students. Think this one through with me.
You should be asking all of your patients if they hurt anywhere, and then get more specific. If they deny pain, then you write on your report that the patient denied pain. If they have pain, then you know that they have pain, and you ask them to rank it on a scale of 1-10. You're not randomly asking this question to everyone.
Here's how I approached it:
Me: Are you hurting or are you experiencing pain anywhere on your body?
Patient: No
Me: Not to sound repetitive, but I just want to me thorough in my evaluation. So you have no head pain?
Patient: No
Me: Neck pain?
Patient: Yes, my neck hurts
Me: On a scale of 1-10, one being very little pain, and 10 being the worst pain you've ever felt, how would you rate your pain? This is where they rate it either a two (little), five (mid), or eight (real bad). I've had very few other numbers
Then you address the issue and continue the evaluation.
If they answer yes to any of those questions, then I know that they have some, and ask them to rate it on a scale of 1-10.
You should be asking all of your patients if they hurt anywhere, and then get more specific. If they deny pain, then you write on your report that the patient denied pain. If they have pain, then you know that they have pain, and you ask them to rank it on a scale of 1-10. You're not randomly asking this question to everyone.
Here's how I approached it:
Me: Are you hurting or are you experiencing pain anywhere on your body?
Patient: No
Me: Not to sound repetitive, but I just want to me thorough in my evaluation. So you have no head pain?
Patient: No
Me: Neck pain?
Patient: Yes, my neck hurts
Me: On a scale of 1-10, one being very little pain, and 10 being the worst pain you've ever felt, how would you rate your pain? This is where they rate it either a two (little), five (mid), or eight (real bad). I've had very few other numbers
Then you address the issue and continue the evaluation.
If they answer yes to any of those questions, then I know that they have some, and ask them to rate it on a scale of 1-10.
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There are nationally accepted scales but you must be aware of and consistent with the scale you are using. There are also studies done with other scales designed for different groupings of patients with different backgrounds as well as different disease processes such as cancer. Some hospice groups have their own scales. Kids and patients with language barriers require a different scale and they can be interpreted differently.
This is a whole science to itself and one that is stressed as a requirement to all healthcare professionals, from CNAs to MDs, for good documentation.
0 - 10 is the more accepted numeric scale.
Here is a link to the NIH for a list of the commonly used scales.
http://painconsortium.nih.gov/pain_scales/index.html
This is a whole science to itself and one that is stressed as a requirement to all healthcare professionals, from CNAs to MDs, for good documentation.
0 - 10 is the more accepted numeric scale.
Here is a link to the NIH for a list of the commonly used scales.
http://painconsortium.nih.gov/pain_scales/index.html
I can understand that, and definitely agree with that. Seems a little over the top for me as well however I can see the point on a continuing evaluation.
Say a patient rated pain at a 4 initially. During your treatment you push some sort of pain med (sorry haven't gotten to pharmacology yet forgive me). After the medication has had time to work you ask again how they rate their pain then I could see a 0 but it is just as easy to say they deny any pain.
Edit: Vent medic thanks for the link and information I'll have to do some reading. All kinds of good information around here.
Say a patient rated pain at a 4 initially. During your treatment you push some sort of pain med (sorry haven't gotten to pharmacology yet forgive me). After the medication has had time to work you ask again how they rate their pain then I could see a 0 but it is just as easy to say they deny any pain.
Edit: Vent medic thanks for the link and information I'll have to do some reading. All kinds of good information around here.
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Seriously, where do you get this crap from?
We just had our JCAHO survey at the hospital.
firecoins
IFT Puppet
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I say 1 to 10 but people say 0 when they have no pain so I guess its understood as 0 to 10.
Let me quote myself from a previous post.
This is important when you are explaining the scale to the patient about how to put a numeric value to their pain. If you are not well informed about your scale or inconsistent in its use, your explaination to the patient will not be clear. The numeric values can also be associated with a treatment plan.
firecoins
IFT Puppet
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scale is pretty clear. everyone understands it and am very consistant in its use. Every MD and RN I watch use the scale have done it in the same exact manner. No one say between zero and 10. They all say 1 and 10.
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Sasha
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Then the hospital I do my clinicals at must be full of no ones! Ive been taught 0-10. I think its really a matter of personal preference.
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It's kind of like the North and the South. Down here they call pop "soda," and eighth-grade "senior year"
As long as everybody in that facility or ambulance service has the same "personal preference". If Provide A uses one scale and then the partner, Provider B uses a different scale, that could lead to confusion in an already confusing situation for the patient.
This is one of the reasons why it is so difficult to pull EMS records for research. People make up their own abbreviations and often use whatever scale they feel like. There is no consistency in education within the schools, departments or even with each individual.
The hospital is following established guidelines or P&Ps and the employees are all on the same page.
mycrofft
Still crazy but elsewhere
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tell them what they want to hear but mutter "It still moves".
JCAH or whatever they are calling themselves this decade are sometimes full of crap. Pain is as subjective as art, and where I work everyone's pain rating is "two hundred, man!!!". Do whatever they want yo to do to pass their little test this year, but never be tricked into hanging your treatment onto a quasi-scientific phlogiston scale like that (i.e., if the pain is below eight you cannot give analgesia, and if it is over eight yo have to give MSO4, or other rot).
Do your best to characterize distress, and ask "better, worse, or the same?" as you need to. I'd rather see a report behind me on the overhead projector reading " 'It feels like a zipper in my chest' and we started two large bore IV's" rather than "Oh, about a four...no, five...no...arrrghh".
JCAH or whatever they are calling themselves this decade are sometimes full of crap. Pain is as subjective as art, and where I work everyone's pain rating is "two hundred, man!!!". Do whatever they want yo to do to pass their little test this year, but never be tricked into hanging your treatment onto a quasi-scientific phlogiston scale like that (i.e., if the pain is below eight you cannot give analgesia, and if it is over eight yo have to give MSO4, or other rot).
Do your best to characterize distress, and ask "better, worse, or the same?" as you need to. I'd rather see a report behind me on the overhead projector reading " 'It feels like a zipper in my chest' and we started two large bore IV's" rather than "Oh, about a four...no, five...no...arrrghh".
We use whatever is appropriate for the patient and that group. That is why I posted the NIH link which gives examples of these scales.
The important part is that the healthcare professional is consistent in their own knowledge of pain scales and how to use them appropriately.
It is mandatory documentation and should not be taken lightly or blown off as a joke. You can do the math when the patient offers their own commentary. That is only commonsense.
Nurses also should be well educated in this starting from their first semester of the nursing program. Some of the older nurses have had to learn the documentation, thus old attitudes toward the scales and reluctance to broaden their education also exists in some places.
The important part is that the healthcare professional is consistent in their own knowledge of pain scales and how to use them appropriately.
It is mandatory documentation and should not be taken lightly or blown off as a joke. You can do the math when the patient offers their own commentary. That is only commonsense.
Nurses also should be well educated in this starting from their first semester of the nursing program. Some of the older nurses have had to learn the documentation, thus old attitudes toward the scales and reluctance to broaden their education also exists in some places.
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And very subjective ones at that.
I've got to say that I've used both scales, depending upon how the patient presents. If I know that they are in pain, I'll use the 1-10 scale. If I'm not sure they're in pain, and am asking the question as part of my general assessment, I'll use the 0-10 scale.
You know, I think I just do it out of habit these days. Plus it's nice to have a number to document. But really, your patient is either in no pain, a little pain, a lot of pain, or incapacitating pain. And it's so obvious without even asking them a question. That being said, the one time I really find it useful is with the administration of Nitro, for obvious reasons. But even then, if they seem unsure of how to answer (as most do), I just simplify it by asking whether it helped reduce the pain at all. I've yet to meet a patient that can put solid numbers to the amount of pain they're feeling. It's either "I'm not in pain" "It hurts a little. I guess a 4 or a 5 or a 6. Maybe 3." "IT HURTS SO MUCH! 20! 100! HELP!" "AAAAAAAAAAAAHHHHHH!" or "I don't know."
mycrofft
Still crazy but elsewhere
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It's a sop to lawyers and deskjockeys. And I'm becoming a Bolshie.
But if used uniformly in an organization it can be a means of communicating and commemorating a clinical finding. I acknowledge that, but I have an everloving bone to pick with rear echelon weenies.
It never ceases to amaze me that JACOH is forever discovering new earthshaking ways to revolutionize healthcare, when they come in, walk over the filthy floors of your overcrowded hospital, take over an office, have your records staff bring over the cherrypicked medical records they will pore over in air conditioned comfort, then drop their little findings about one through ten (or is it "one TO ten"?) onto you like dingleberries from on high. They should have a term limit (one year) and be forced to go through five years of line work before they are allowed to become an inspector again.
Years ago, they declared that pain control is the battleline, when infection control, overutilized ED's and overpaid fatcat administrators, including much of JACOH, are the real cancer in the system. The objective result is the epidemic of Rx addiction, and the closure of essential medical facilites due to financial collapse and failure to pass standards.
So sez me. Open fire. (And I SO did like it here.....).
But if used uniformly in an organization it can be a means of communicating and commemorating a clinical finding. I acknowledge that, but I have an everloving bone to pick with rear echelon weenies.
It never ceases to amaze me that JACOH is forever discovering new earthshaking ways to revolutionize healthcare, when they come in, walk over the filthy floors of your overcrowded hospital, take over an office, have your records staff bring over the cherrypicked medical records they will pore over in air conditioned comfort, then drop their little findings about one through ten (or is it "one TO ten"?) onto you like dingleberries from on high. They should have a term limit (one year) and be forced to go through five years of line work before they are allowed to become an inspector again.
Years ago, they declared that pain control is the battleline, when infection control, overutilized ED's and overpaid fatcat administrators, including much of JACOH, are the real cancer in the system. The objective result is the epidemic of Rx addiction, and the closure of essential medical facilites due to financial collapse and failure to pass standards.
So sez me. Open fire. (And I SO did like it here.....).
Ridryder911
EMS Guru
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0-10 meaning zero is no pain. One would be having some pain. Many people have a hard determining what levels are so I illustrate it; that a 10 could be similar to me taking their hand and placing it into a car door and slamming it. That usually gives them a hint...
Steve Berry has a humorous lecture on asking what pain level they would like, he describes his CRNA saying we are too concrete, that actually we can have a -3 or -4 .. of course this is when it is easy to set off the apnea alarms. He also does not recommend it as well due to the related nausea with the medicine.
R/r 911
Steve Berry has a humorous lecture on asking what pain level they would like, he describes his CRNA saying we are too concrete, that actually we can have a -3 or -4 .. of course this is when it is easy to set off the apnea alarms. He also does not recommend it as well due to the related nausea with the medicine.
R/r 911