Aggravated DocSurg explores the downside of the “fifth” vital sign:
Couple that issue with the militant attitude of JACHO [sic] —-there shall be no pain!!— whose guidelines insisted that anyone with a pain score greater than 5 must be reassessed. In the real world, unless a nurse wants to go through the headache of extra paperwork, reassessment means “remedicate.” And, of course, there is the all-too-frequent patient who describes pain as being “10 out of 10″ as soon as he is arouse from a profoundly deep, narcotic induced sleep; how does one truly rate him with JCAHO’s mandates in mind?And that, my friends, is how we have gotten into the pickle of potentially overmedicating, overnarcotizing, and oversedating patients sometimes to dangerous levels. That doesn’t just lead to sleepy patients……it can lead to death.
Related posts:
- Why primary care doctors shouldn’t be pain specialists
- Treating chronic pain with narcotics and avoiding the risk of addiction
- Pain management and addiction
- Should some doctors be restricted from prescribing narcotic pain medications?
- Opioids and back pain
- Patient satisfaction vs pain relief
- Cursing can kill pain, I swear
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{ 4 comments }
It might help to stop indulging the idiotic notion that pain is a “vital sign.” Pain is a complaint and it is an element of history. It is a symptom, sometimes. It cannot be measured objectively. Vital signs can be measured, obviously. If extreme pain causes tachycardia and hypertension, those are the things that should be measured. Smilie-face/frownie-face is for morons.
Stupid people and thoughtless panderers think that calling pain a vital sign makes it one. That is a disservice to the discipline required of medical decision making. It is unfortunately a result of allowing persons not fully responsible for medical decisions to say what should be important and what should not.
I was going to point out that a “sign” can be objectively assessed, pain cannot. The example of the patient awakening from a narcotic sleep and complaining of 10/10 pain is an excellent example of why it is a symptom, not a sign. But anonymous 9:37 beat me to it.
Screw the Joint Commision. No one should let them dictate how to medicate patients. Let them stick to issues like the width of the hallway and the number of trash cans.
My experience has been in the ER. I have seen numerous near misses (patients needing reversal) and am aware of a few clean kills related to over aggressive pain management in a busy ED without the depth in Staffing to provide sufficient monitoring of the practice. I have seen numerous people who “Had a Ride” lie or sneak out and drive after being well medicated. I call in a report and turn in a DMV form when I see it happen. How do we measure how many people that has knocked off over the years on the roads by one of these Customers. Wont ever be measured and the reports will be anecdotal so it will be ignored in the pain management debate.
I see this problem as getting worse and now being driven by the desire to produce high patient satisfaction scores which is reflected by improper intervention in medical decisions by Hospital Administrators.
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