Bold Voices - December 2011 - (Page 11)

AT THE BEDSIDE ‘Pain Code’ Encourages Use of Maximum Dosage AACN Resources for Managing Patient Pain • “Managing Pain, Delirium and Sedation” — Critical Care Nurse supplement article • “Patient Satisfaction and Documentation of Pain Assessments and Management After Implementing the Adult Nonverbal Pain Scale” — American Journal of Critical Care article • Promoting Excellence in Palliative and End-of-Life Care — e-learning course • Self-Assessment: Palliative and End-of-Life Care • “Compact Clinical Guide to Acute Pain Management: An EBP Approach for Nurses” — in AACN Online Bookstore You’ll find direct links to these and other resources in this issue’s digital edition at T he key to quickly controlling a pain crisis is dosing to maximum concentration every time, advises Charles F. von Gunten, provost of The Institute for Palliative Medicine at San Diego Hospice. In a video that appears on Medscape (free sign-up required), von Gunten describes using a “pain code” to treat an advanced cancer Quickly get on top patient who experiences 10 out of 10 pain. of a pain crisis. Maximum concentration of morphine takes eight minutes, which means successive doses can be given every eight minutes and should be doubled each time. For example, if the patient is on a controlled analgesia dose of 1 mg of morphine: • Double it to 2 mg. • After eight minutes, increase it to 4 mg. • If there’s still no relief after eight minutes, double it to 8 mg. • Wait 8 minutes. Give 16 mg. • When the patient begins to describe relief, you’ve found the right dose. von Gunten calls dosing every half-life “the most frequent mistake people make.” He adds, “When someone is in a pain crisis, you want to get on top of that pain quickly. You want to avoid the demoralization that comes from not being able to deal with the pain right away.” Weigh in. What is your experience with dosing pain medication to maximum concentration? Tell us at aacnboldvoices, or post a comment on our wall at /aacnface. AACN BOLD VOICES DECEMBER 2011 11

Table of Contents for the Digital Edition of Bold Voices - December 2011

Front/Digital Edition Viewing Guide
Another Angle
AACN Boards and Contact Information
Dec. 19 Deadline: National Awards Recognize Excellence, Leadership in HAI Prevention
Box Office Hit 'Contagion' Raises Questions About Virus
New Privacy Recommendations for Storing Newborn Screening Specimens
Motor Training Can Advance Social Development in Infants With Autism
In-Hospital Mobility Benefits Older Patients
NSAIDs May Harm Patients with Heart Disease, Hypertension
Pain Code' Encourages Use of Maximum Dosage
FDA's Treatment Recommendations for Simvastatin 80
Study Identifies Predictors of Sudden Cardiac Death Versus Surviving Heart Attack
Study Seeks Initiator of Post-Trauma Intestinal Cell Damage
Australian Study: 'How Dangerous is a Day in Hospital'
In Our Journals
ICU Staff Composition May Decrease Burnout
Use of Manikins May Improve Emergency Care
Celebrate Certification
AACN Financials
From the President

Bold Voices - December 2011