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Legally speaking: Follow policy while relieving patients’ pain

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One of the many advantages of today’s 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 patient’s 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 provider’s 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 state’s 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 Association’s “Pain Management Nursing: Scope and Standards of Practice” is an essential resource.

Here are some additional tips to consider:

Never stop learning about pain — how it is manifested, physiological and psychological symptoms, assessment and treatment — 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 patient’s 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)

Allegation:
RN didn’t follow plan of care; told staff to withhold narcotic patch; did not understand function of narcotic patch; did not tell family of changes in patient’s medications; did not administer adequate amounts of liquid narcotic. This resulted in patient’s death.

Jury verdict:
Negligence claim against nurse affirmed on appeal.

Case: Mobile Infirmary Association v. Tyler (2007)

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

Jury verdict:
Wrongful death claim affirmed on appeal.

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

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About Author

Nancy J. Brent, RN, MS, JD, is Nurse.com’s 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.

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