CLINICAL GUIDELINE FOR REFERRAL TO PAIN SERVICE 1. Aim/Purpose of this Guideline To provide guidance for appropriate referral to the acute pain service for in-patient review. 2. The Guidance PAIN SERVICES REFERRAL IN- PATIENT SERVICES PROVIDED FOR PATIENTS ACUTE OR POST OP PAIN CHRONIC OR COMPLEX PAIN Pain control problem despite the regular administration of prescribed analgesia as per EPMA. Consistent 3. pain score of 2 or above on NEWS chart. Uncontrolled pain despite optimised specific mode of analgesia 4. E.g. PCA, epidural, local nerve infiltration. Equipment concerns. Unwanted 5. analgesia side effects or critical incidence advice. Advice requested from multidisciplinary team following review of patient by named Consultant team. 6. 7. 8. 9. CONTACT DETAILS Monday to Friday 08:30 16:30 via Bleep 3233 +/- Maxims for complex or chronic pain referrals. OUT OF HOURS For acute pain issues contact on-call anaesthetist via switchboard. 3. Monitoring compliance and effectiveness Prescribe and administer analgesia as per EPMA. Commence appropriate investigations of potential causes of pain. For telephone advice, contact Pain Specialist Nurses via Bleep 3233. Medical/Surgical team to send electronic referral via Maxims. If urgent review required, referring team to contact Pain Specialist Nurses via bleep 3233 AND complete electronic Maxims referral. All referrals will be assessed within 24 hours by Pain Specialist Nurses during identified working hours. OUTPATIENT REFERRAL TO PAIN SERVICES For all outpatient referrals to the Pain Service, discharging team to identify on discharge paperwork or Consultant correspondence. CANCER PAIN Refer to Palliative Team Element to be monitored Lead Tool Frequency Reporting arrangements Adherence to the guideline for in-patient pain team referrals. Dr Nicholas Marshall, Consultant Anaesthetist, Acute Pain Lead. Audit of electronic referrals via MAXIMS. 5 yearly. The audit results will be reported to the Acute Pain Lead Consultant and the Pain Service Governance Lead Consultant. Page 1 of 6
Acting on recommendations and Lead(s) Change in practice and lessons to be shared Documented recommendations made, acted on and amended within a specific time frame by Acute Pain Team and Dr Nicholas Marshall. Practice changes will be implemented. Required changes to practice will be identified and actioned within 1 month, depending on changes required. A lead member of the team will be identified to take each lesson forward where appropriate. Lessons will be shared with relevant stakeholders. 4. Equality and Diversity 4.1 This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website. 4.2 Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 2 of 6
Appendix 1. Governance Information Document Title Pain Services Referral Date Issued/Approved: 21 May 2015 Date Valid From: 21 May 2015 Date Valid To: 21 May 2018 Directorate / Department responsible (author/owner): Theatre and Anaesthetics Directorate, Pain Services. Emma Harrison, Pain Specialist Nurse. Contact details: (01872) 252095/252172 Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: 11/5/15 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Guideline of how to refer to Pain Services for patient review. Pain Services, Pain Team, Acute Pain, Referral, Chronic Pain, Complex Pain, Postoperative Pain. RCHT PCH CFT KCCG Executive Medical Director, Dr Rob Parry. PAIN SERVICES REFERRAL Pain Services, RCHT Governance, RCHT Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Training Need Identified? Mr Duncan Bliss Dr Keith Mitchell (Pain Governance Lead) {Original copy signed} Internet & Intranet Intranet Only Document library and Pain Sub folder ne ne Page 3 of 6
Version Control Table Date Version Summary of Changes Changes Made by (Name and Job Title) 17April 12 V2.0 28 May 15 V3.0 Published on current hospital template and headings. Changed to current hospital template. Pain Specialist Nurses bleep number changed to 3233. Guideline updated to reflect change Guideline updated due to expiry of present version. Guideline updated to reflect changes to electronic referral process for patients with chronic and complex pain Guideline amended to include guidance for outpatient referral to Pain Services. Sharon Dunstan, Pain Specialist Nurse. Emma Harrison, Pain Specialist Nurse All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 4 of 6
Appendix 2. Initial Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Directorate and service area: Pain Is this a new or existing Policy? Existing policy Services Name of individual completing Telephone: (01872) 252095/252172 assessment: Emma Harrison 1. Policy Aim* Aimed at nursing and medical staff. Who is the strategy / policy / proposal / service function aimed at? 2. Policy Objectives* To provide supporting guidance on appropriate referral to Pain Services. 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. To standardise referrals for in-patient pain reviews. Patient satisfaction regarding pain control. Appropriate referrals made. Patients, medical, nursing and allied health care professional team. On initial proposal Practice Development and Infection Control 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability learning disability, physical disability, sensory impairment and mental health problems Page 5 of 6
Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 6 of 6