This next exercise for the PreEmpt Pain smartphone app jumps right into the most valuable asset of the clinical decision tool - a plan that can be developed quickly with just a few taps through the screens.
The components of these two screens include:
- appropriate pain scale
- first-line treatment (medications that should
be considered first above all others)
- non-pharmacologic strategies
- adjunctive treatments to prevent or avoid
side effects such as pruritus, constipation
- consideration for the need for opioids if
- oral opioids
- IV opioids
- breakthrough dose of opioids
Tapping on the links in the app will bring you to a separate page giving you the various options available for your choosing. Making those choices populates the final plan pages in not only the Quick Plan option but also in the Comprehensive Plan.
I think it is important that the final plan is available in one or two screens that show the plan clearly. This not only provides you a good start for the pain plan but can also serve as a note template for your documentation in the medical record.
When considering if opioids are appropriate, certain rules should be kept in mind regarding their safe and appropriate use.
- Opioids should only be considered in those procedures / conditions associated with moderate or intense pain (I provide some examples of those procedures in the app in the Expected Pain Intensity screen (more on this in another post)
- If the gut works, use it. Oral opioids are preferred over IV opioids (but dependent upon the setting and patient disposition).
- Only one specific opioid should be ordered at a time. It is not beneficial (and can be unsafe) to combine for example use of oxycodone and tramadol.
- If you have inadvertently ordered two
different oral opioids, you have the option to
eliminate your unwanted choices
- You can tap the 'Restore' button in the event
you have deleted the options erroneously
- You can tap the 'Reload' button to reload the
pages and see all of the options you have deleted
- IV PCA should ideally be used only for those individuals undergoing procedures or having medical conditions associated with intense pain (i.e., severe oral mucositis) where oral medications are difficult to control the pain or patients are NPO. The need for PCA should be reassessed on a daily basis and transition to oral in a timely fashion.
- IV opioids are again used in those individuals that need quick treatment of their pain associated with a moderate to intense pain.
- Notes - this field on the bottom of the page allows free text notes regarding follow-up or special considerations. Notes entry is launched from a separate page and populates the Quick Plan and the Comprehensive Plan screens. Tap on the link, enter your note, then 'back-arrow' the the Quick Plan page to see your note entry.
Check out for yourself how the Quick Plan works for you. This is a worthwhile exercise for a real or virtual patient.
- Did the quick plan give you any new ideas of how to manage pain and symptoms?
- Is there something else you would like to see in the Quick Plan?
I would appreciate your feedback, the ease of using the buttons, and any constructive criticism you have for this exercise and the app in general.