1. Creating Better Pain
Management through Clinical
Simulation
Hollie Adejumo
Howard High School

2. What is Pain?
An "unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage.“
-The International Association for the
Study of Pain
http://health.howstuffworks.com/diseases-conditions/pai

3. Types of Pain
 Acute or Transient pain
 Chronic or Persistent Pain
 Cancer Pain
http://health.howstuffworks.com/diseases-conditions/headache/10-
types-of-headaches.htm

4. Methods of Managing Pain
• Internal Procedures
• Medication
• Therapy
• Alternative
Therapies
• Counseling and
Support
Acupuncture is a common
alternative method for relieving pain
http://health.howstuffworks.com/wellness/natural-medicine/chinese/acupuncture.htm

5. Measuring Pain
“Pain is whatever the experiencing patient says it is,
existing when she/he says it does” –McCaffery and
Pasero (1999)
 Patient’s Perspective:
◦ Demands physical, emotional, and mental
energy
 Provider’s Perspective:
◦ Assessed by looking at a patient’s report, not
the predicted signs and symptoms
◦ Patients tells if pain is present and what it is
like

6. Types of Pain Medication
 Non-Opioid Analgesics
 Opioid Analgesics

7. Effective Pain Management
http://www.wllc.com/blog/preventing-medication-errors.cfm
 Combine opioid and non-opioid
pharmaceuticals
 Timely administration

8. Patient Concerns
 Psychological Dependence
 Drug Tolerance
 Physical Dependence
 Addiction

9. Effective Pain Management and
Considerations
 Understand a patient’s cultural
differences in pain expression
◦ Different cultures may have different ideas
of the meaning of pain
 Assess the meaning of pain to a
patient

10. Pain Assessment Tools
 OPQRSTU
 Pain Scales
http://savvypatient.org

11. OPQRSTU of Pain
Assessment
O nset
P rovocative/Palliative Factors
Q uality (Open Ended Questions)
R egion/Radiation
S everity
Timing
U You
“How does pain affect you?”

12. Pain Scales
 Numerical Rating
 Wong-Baker
 Verbal Rating
 Observer Scales

13. Numerical Rating Scale
http://understandingpain.wordpress.com/category/pain-assessment-tools/

14. Wong-Baker Scale
http://understandingpain.wordpress.com/category/pain-assessment-tools/

15. Verbal Rating Scale- McGill Pain
Questionnaire
http://pain.about.com/od/testingdiagnosis/ig/pain-scales/McGill-Pain-Scale.htm

16. Observer Pain Scales
http://0.tqn.com/d/pain/1/0/V/-/-/-/FLACC.gif

17. Using Pain Scales to Make
Decisions about Pain Medication
 Pain Scales make the pain
measurable
 Helps to determine if pain is mild,
moderate, or severe
 Makes it easier to find an effective
dose

18. Factors Considered when
Determining Medication Dosage
• History of a patient’s pain
• Pain intensity
• Duration of Pain
• Aggravating and Relieving Conditions
• Determine the cause of the pain

19. Clinical Simulation-Based
Training
 “Simulation is a technique – not a technology –
to replace or amplify real experiences with
guided experiences that evoke or replicate
substantial aspects of the real world in a fully
interactive manner.” – David M. Gaba, Stanford
University
 Examples:
◦ Standardized Patients
◦ Mannequins
◦ Computer-Based Simulation Used to build a safer health
system by providing guided
practice
http://blog.hospitalclinic.org/en/2009/05/nou-laboratori-de-simulacio-
clinica-de-la-facultat-de-medicina/

20. Benefits of Clinical Simulation
http://www.temple.edu/ics/programs/medicine/fy2.html
• Provides a variety of real-life situations
• Opportunity to repeatedly practice without
real patients
• Convenient
• Active learning and Concentration
• Increases collaboration within medical
teams

21. Standardized Patient
•An actor trained to portray the role of a
patient, family member, or another
individual
•Simulate in a standardized manner
http://www.temple.edu/ics/about/standardized.ht
ml
http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index.
html

22. Resident Problems with Opioid
Decision Making
 Lack of Confidence
 Poor Interviewing Technique
 Lack of Opioid Knowledge
 Poor written orders for medication
 Inconsistent use of drug calculations
to determine drug doses

23. Improving Opioid Decision
Making with Clinical Simulation-
Based Training
 Goals:
◦ To improve physician confidence when
working with a patient experiencing pain
◦ To use drug calculations when making
opioid decisions
◦ To write appropriate orders
http://zotzine.uci.edu/2009_04/patient.php

24. Assessing a Patient with Pain
• Describe the Pain Scale Appropriately
• Ask patient of history of addiction
• Discuss addiction vs. dependence
• Ask about opioid related side effects
• Assess for constipation
• Address the fear of addiction
• Make correct doses

25. Results
 More comfortable with making
dosage decisions
 Increase in confidence
http://blog.soliant.com/doctor-and-physician-salary-
ranges-average-salaries-and-educational-
requirements/
 More frequent use of opioid conversions
 Not much effect on writing appropriate
orders

26. Improving Results in the
Future
 Continuous education and regular
review will continue to improve
resident physician skills
http://www.thedoctorweighsin.com/%E2%80%9Ctake-this-medication-okay-taking-a-look-at-emergency-department-discharge-instructions/

27. Acknowledgements
 I would like to thank Ms. Emily Shaw,
Ms. Kat Walker, and all of the other
staff at the Simulation Center for
helping to make this project possible