Is The 5th Vital Sign Valid? |
by Tim Gieseke, MD, CMD Over the last 15 years, all levels of medicine have emphasized the need for early recognition and appropriate management of pain. One of the mantras of this campaign has been the dogma that only the patient can tell us the severity of their pain. We have supported this construct with efforts to quantify pain severity using a variety of pain assessment tools including: pain thermometers, faces, alphanumeric scales, and qualitative descriptors. Using these tools, our nurses have put a # to this 5th vital sign. This # has also become the key metric on our MARs for the success (or failure) of our interventions to control the identified pain.
I propose that the 5th vital sign needs to be normalized. After all, the reason we focus on pain care, has been to ensure that pain’s known adverse effects on function and quality of life are mitigated. Patient centered care and good medical care demand that we pay more attention to how pain adversely affects a particular patient’s function and QOL. Pain commonly adversely affects: sleep, meal intake, mobility, mood disorders, and rehabilitation and social engagement. If a patient is sleeping and eating well, participating in social activities, and is progressing appropriately in rehab, a nurse should be permitted to normalize the alpha numeric pain report of 7-10 down to the 3-5 range, since those functions would rarely be possible if the patient were truly in severe pain. Pain at this level still requires a detailed care plan, but it certainly doesn’t call for new potentially risky pain interventions. |