Promoting Evidence-Based Practice and Dispelling Urban Legends to Achieve Safer Pain Management

Abstract

TODAY, MANY NURSES in the perianesthesia setting help patients control their pain by administering pain medications prescribed by orders in which the analgesic medication is dosed according to pain intensity (either number or descriptive word). Many nurses find this practice challenging, particularly when patients are stirred and then report high numeric pain ratings, yet are noted to be somnolent. This practice of tying an analgesic dose to a pain intensity rating is relatively new, beginning early in the 21st century when a movement started to eliminate as needed (prn) range orders. 1 Crea K.A. Morehead D. Snow R. Reducing adverse drug events involving high-risk medications in acute care. JCOM. 2004; 11: 640-646 Google Scholar , 2 Rich D.S. Point-of-care automated dispensing devices; herbal products; proper medication orders; expiration dating. Hosp Pharm. 1999; 34: 989-996 Crossref Scopus (3) Google Scholar One argument made for eliminating prn range orders was to improve patient safety. 1 Crea K.A. Morehead D. Snow R. Reducing adverse drug events involving high-risk medications in acute care. JCOM. 2004; 11: 640-646 Google Scholar This argument is fraught with irony, contradiction, and misinformation. It is ironic because despite a search of PubMed, the US National Library of Medicine, Medline Plus, Centers for Disease Control and Prevention, the Institute for Safe Medication Practices (ISMP), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature, no data could be found regarding any adverse events related to the use of range orders. Paradoxically, the practice of dosing to a particular number or pain intensity has caused significant adverse events. 3 Pasero C. Quinlan-Colwell A. Rae D. Broglio K. Drew D. American Society for Pain Management Nursing position statement: Prescribing and administering opioid doses based solely on pain intensity. Pain Manag Nurs. 2016; 17: 170-180 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar An interesting statement from ISMP in 2002 called for elimination of orders with dosage ranges, but, in the same article, encouraged clinicians to use their professional judgment to assess patients for objective criteria and safety factors as opposed to only linking medication dosages to the self-assessment of pain by the patient. 4 Institute for Safe Medication Practices (ISMP)Pain Scales Don't Weigh Every Risk. 2002https://www.ismp.org/newsletters/acutecare/articles/20020724.aspDate accessed: November 18, 2017 Google Scholar Considering the misinformation and confusion, it is important to clarify the terms used. Ann Quinlan-Colwell, PhD, RN-BC, DAAPM, New Hanover Regional Medical Center, Wilmington, NC.