screening for pain in tswf forms using the defense and ...€¦ · they pertain to the defense and...

Screening for Pain in TSWF forms using the Defense and Veterans Pain Rating Scale

(DVPRS)

“Medically Ready Force…Ready Medical Force”

Disclaimer

• The views expressed are those of the author and do not reflect the official policy of the Department of Defense (DoD), the U.S. Public Health Service, or the U.S. Government.

• Content shown is from an AHLTA Training System (ATS) and does not contain actual patient data.


Recent Changes

The following slides reflect recent changes made to this form.

Multiple form Update*except MHSPHP, SHPE, mTBI, In/Out processing, Sports Med, CM, CM Peds, Peds Nrsg and entire Peds suite

Note: The clinical clue ‘Look carefully at the

pain scale. How would you rate your pain right

now?’

Updated the DVPRS score from free text to radio button selections

(see further training here: www.tswf-mhs.com/dvprs-mhss-pain-assessment/)

See link to DVPRS scale

4

Removed old 0-10 pain scale

May-Aug 2019 Next update Sept 2019

Multiple form Update*except MHSPHP, SHPE, mTBI, In/Out processing, Sports Med, CM, CM Peds, Peds Nrsg and entire Peds suite

Updated the Pain Functional Impact Assessment questions from free text to radio button selections

5May-Aug 2019

Next update Sept 2019

Objectives

Training Objective:

Identify the clinical workflows, screeners and tools available in the TSWF AIM Forms as they pertain to the Defense and Veterans Pain Rating Scale (DVPRS)

Learning Objectives:

At the conclusion of today’s activity, the participant will be able to:

• Accurately screen patients for pain using the Defense and Veterans Pain Rating Scale (DVPRS) (Slides 7-15)

• Document DVPRS scores correctly in the electronic health record (Slides 16-18)


DVPRS Screening Questions

• DVPRS is the standard pain rating scale for the military health system

• DVPRS has 2 parts:

‒ Initial pain intensity question completed on all patients

‒ Four supplemental questions measuring impact of pain on activity, sleep, mood and stress to be completed on:

▪ Patients reporting a pain severity of 4 or greater*

▪ Patients not responding to the expected course of recovery

• A copy of the scale must be available for the patient to see each time it is used

Information from DVPRS from Dvcipm.org*see speaker notes for explanation of this threshold


Properly Delivering DVPRS Pain Intensity Question

Information from DVPRS from Dvcipm.org

When using DVPRS, the screener will:• Point out the scale components

‒ Faces‒ Color coded bars‒ Word descriptors

• Allow patient time to: ‒ Look at the scale ‒ Read the word descriptors

• Ask: ‒ “Look carefully at the pain scale. How would you rate your pain

right now?”• Document responses in the TSWF form (see slides 16-18)


DVPRS Supplemental Questions for Pain Intensity Score of Four or Greater

When pain intensity response is four or greater:

• Orient patient to supplemental questions, used to assess functional impact

• Instruct patient, “Using these 0-10 scales, answer the following questions about the last 24 hours.”

• Supplemental questions are not applicable when pain began earlier in the day of appointment

• Document DVPRS responses in the TSWF CORE Form (see slides 13-15)


Appropriate Use of DVPRS: Patient Population

DVPRS:

• Should be used with adult patients

• Has not been tested in pediatric patients or patients with cognitive impairment

• Consider appropriateness of use in patients with traumatic brain injury who are experiencing short-term memory loss. These patients may be able to answer their pain intensity “right now,” but may be unable to give information on average pain over 24 hours or the supplemental questions

• Patients with color blindness should be oriented to other features of the scale

Information from DVPRS from Dvcipm.org


Effective Screening Practices

• Preferred: show the hard copy; alternative: read questions verbatim

- Questions were studied how they are written on the form

- Changing a question’s wording can alter its meaning and the PCMH team’s understanding of the patient’s pain experience

• Do not comment or offer feedback after a patient’s responses (e.g., “okay, good”, “that’s great”, etc.)

- Comments provide feedback to a patient (e.g., that is good that you do not have pain)

- Comments may imply that a patient should or should not share information with you in the future


Case Example #1DVPRS Pain Intensity Items

SGT Carson is a 35-year-old man who presents for a primary care appointment for cough. The screener administers the DVPRS pain intensity items:

• Pain right now

- Screener: “Look carefully at the pain scale. How would you rate your pain right now?”

- SGT Carson: “Five”

• Since the response is > 4, administer supplemental questions


Case Example #2DVPRS Supplemental Questions

“SGT Carson, I am going to ask you a few additional questions. Using these ‘0-10’ scales, answer the following questions about the last 24 hours.”


Group Discussion…

Why is it important to ask all screening questions “verbatim,” meaning exactly as written?

Why is it important to ask the DVPRS supplemental questions when patients have a

pain intensity score of 4 or greater?


Using Your WorkflowKnowledge Check:

• The patient is a 47-year-old beneficiary with a scheduled appointment for sleep disturbance. The patient’s rating on the pain intensity item is three. What action does the screener take?

• Your patient is a 58-year-old woman with chronic low back pain for three months. She reports her current pain intensity as five. What action does the screener take?


Documenting DVPRS Scores in the TSWF CORE Form

• New ribbon in the HPI tab, TSWF CORE form:



• Linked reference:

• Link: http://www.dvcipm.org/site/assets/files/1084/dvprs_single_page.pdf



• When the DVPRS ribbon is opened, additional pain documentation fields are revealed, including the new DVPRS supplemental questions to assess “functional impact”


TSWF Resource Material

The TSWF repository for training/educational materials and updates:www.tswf-mhs.com/

Comments or Feedback

Contact

- Form feedback / discussion forums: https://www.milsuite.mil/book/groups/tswf

- TSWF resources / educational materials: www.tswf-mhs.com

- Local Clinical Systems Trainer (CST)

https://www.milsuite.mil/book/groups/tswf

https://www.tswf-mhs.com/

TSWF Content Management Sub-Working Group

▪ CHAIR - Maj Matthew J Royall▪ ARMY - Dr. Robert Marshall▪ NAVY - CDR Anja Dabelic▪ AIR FORCE - Lt Col Thomas Mahoney▪ DHA – CPT Hudson-Odoi

TSWF Feedback https://www.milsuite.mil/book/groups/tswfTSWF Website http://www.tswf-mhs.com/

https://www.milsuite.mil/book/groups/tswf

http://www.tswf-mhs.com/

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