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Legally speaking: Follow policy while relieving patientsí pain

Thursday March 20, 2014
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One of the many advantages of todayís medical achievements is the ability to manage acute and chronic patient pain. Many now consider it a fundamental human right to be free from pain and suffering from any medical condition. But controlling a patientís pain is not without its legal conundrums.

Allegations against healthcare providers, including nurses, involved in the management of patient pain have included under-treatment of pain, elder abuse, over-treatment of pain, aiding a known or suspected patient with a history of addiction, and the diversion of patient pain medications for the healthcare providerís own use.

One of the best ways you can avoid legal difficulties is with regular, consistent and thorough patient assessments that are timely, accurate, complete and documented in the patient medical record. Likewise, the administration of any medication to control pain must be done in accordance with standards of medication administration, be consistent with orders by physicians or APNs, be documented clearly and accurately, and comply with mandates from the U.S. Drug Enforcement Administration, and your stateís pharmacy laws and nurse practice act and rules.

Necessary to any nursing care of a patient is your adherence to standards of practice. The American Nurses Associationís ďPain Management Nursing: Scope and Standards of PracticeĒ is an essential resource.

Here are some additional tips to consider:

Never stop learning about pain ó how it is manifested, physiological and psychological symptoms, assessment and treatment ó through continuing education programs, nursing journals and textbooks.

Identify cultural differences in response to pain and its treatment.

Where available and when needed, utilize pain consultant management and treatment.

Know your state nurse practice act and its requirements concerning your practice, as it relates to pain management and treatment and your obligations to patients in your practice generally.

Follow institutional policies for administration of pain medications without fail, and if you have questions about the policies, check with your nurse manager and CNO.

Improve your documentation of a patientís pain level; physiological signs; interventions; and who and when you alerted others if the pain level does not improve.

Assess and treat side effects of pain medication.

Teach the patient and the family about the pain management plan, their role in it, the harmful effects of unrelieved pain and overcoming barriers to effective pain management.

Knowing how to provide help to manage pain while, at the same time, protecting yourself against possible allegations of mismanagement pain is crucial.

A look at two pain management-related court cases

Case: Tolliver v. VNA, Midlands (2009)

RN didnít follow plan of care; told staff to withhold narcotic patch; did not understand function of narcotic patch; did not tell family of changes in patientís medications; did not administer adequate amounts of liquid narcotic. This resulted in patientís death.

Jury verdict:
Negligence claim against nurse affirmed on appeal.

Case: Mobile Infirmary Association v. Tyler (2007)

RN failed to adequately and accurately tell patientís physicians of the nature and severity of patientís abdominal pain due to undiagnosed intestinal necrosis and an infection, which caused the patientís death.

Jury verdict:
Wrongful death claim affirmed on appeal.

To see what else is trending in pain management, visit www.Nurse.com/Pain-Management.


International Association for the Study of Pain (2010). Ethics and Pain Fact Sheet

Joint Committee on Biomedical Ethics of the Los Angeles County Medical Association and Los Angeles County Bar Association (2012). Avoiding Problems with Pain Management: Ethical and Legal Guidelines For Physicians.

Maryland Board of Nursingís Pain Management Nursing Role/Core Competency - A Guide for Nurses

The ANAís Guide to the Code of Ethics for Nurses: Interpretation and Applications, 2008

Nancy J. Brent, RN, MS, JD, is Nurse.comís legal information columnist and an attorney in private practice. Legally speaking is for educational purposes only and is not to be taken as specific legal or other advice by the reader. Post a comment below or email specialty@Nurse.com.