• Document: The Bolton Pain Assessment Tool: Development & Initial Testing. Dr Julie Gregory Nurse Lecturer (Acute Pain Nurse)
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The Bolton Pain Assessment Tool: Development & Initial Testing Dr Julie Gregory Nurse Lecturer (Acute Pain Nurse) Julie.gregory@manchester.ac.uk • Pain common symptom • Management of pain – improves function, reduces complications and hospital stay • need to recognise and assess pain Nurses • Ethical and professional responsibility to assess and treat pain • Need to be aware of: • strategies to assess pain • Barriers to assessment • Communication difficulties are a major barrier Pain Perception • “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” (IASP, 1994, p210) • Pain is composed of highly interactive emotional cognitive and sensory components • It is Subjective OR “Pain is whatever the patient says it is” Pain Assessment • The Gold Standard Or • Most reliable indicator of pain intensity and experience is Self Report • Use of numerical score, verbal descriptor score Pain Assessment and Cognitive Impairment • Self-report of pain should always be attempted & found to be suitable for many people: • 68% with moderate to severe impairment (n = 59). Attempt initially and adopt wording if necessary (instruction s up to 3 times) (Closs et al. 2004) • 60% to 70% mild to moderate cognitive impairment Verbal Descriptor Scale can be used (Kaasalainen & Crook 2004) • Moderate dementia 60% NRS and 90% VDS (No repeated instructions) (Lukas et al 2013) But ……….. Self Report Requires • Communication • Conscious level • Understanding of the pain rating • Memory of a painful event • Interpretation of noxious stimuli (Buffum et al 2007) Problem • Undetected – misinterpreted – inaccurately assessed under-treated. • Hip fracture patients with cognitive impairment – one third amount of morphine administered compared to cognitively intact. • 76% - no prescription for post operative analgesia (Scherder et al 2009) Indicators of pain • What behaviours may indicate pain? Some Symptoms of Pain Behaviour Pacing, crying out, aggression, confusion, social withdrawal, apathy Literature • Difficulties in assessment of pain identified • 158 indicators of pain • Identified by 109 nurses • Variation (Zwakhalen et al 2004) Behaviours associated with pain (AGS 2002) • Vocalisation – Shout • Facial grimace • Body language – Rubbing, guarding • Changes in behaviour – aggression, resists movement • Physiological change – Increase HR, BP, sweating • Physical changes – Skin damage, fractures, Behavioural pain assessment tools • Various available • Numerous concerns – Validity etc • Not used in practice – Lacks user friendly Pilot survey of the use of Behavioural or Observational Pain Assessment Tools BEHAVIOURAL SCALE ABBEY PAINAD FLACC ICU ABBEY /ICU NONE Pain meeting 10 1 1 2 5 University 1 1 17 Total 10 2 1 1 2 22 • 58% used an observational pain assessment tool • Three hospitals use the Abbey pain scale, (The two nurses indicated they used the PAINAD did not record which hospital they represented.) (Gregory and Richardson 2014) Assessment Tool Area of practice Type of pain The Abbey Scale Long Term Care (LTC) Acute & Chronic ADD (Assessment of Acute & Chronic Discomfort in Dementia) LTC CNVI ( Checklist of Non Verbal Acute Care Acute &Chronic Pain Indicators ) LTC MOBID ( Mobilization LTC Excluded acutely ill Observation Behaviour Intensity Dementia Pain Scale) PACSLAC ( Pain Assessment LTC Chronic pain Scale for Seniors with Severe Dementia ) PAINAD (Pain Assessment in LTC Acute & Chronic Advanced Dementia ) PADE (Pain Assessment in LTC 24 items Dementing Elderly) PATCOA (Pain Assessment To Acute Care 22 items Confused Older Adults) DEVELOPMENT OF BEHAVIOURAL PAIN ASSESS

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