Pain and discharge planning

We can help patients make a smooth transition from hospital to their home or residential aged care facility by planning their discharge and providing information about what to do when they leave hospital.

Develop a discharge plan

Pain should be assessed as part of hospital discharge.

Allow enough time to develop a pain management discharge plan with the older person and their family or carer.

Ensure the person’s GP and other healthcare professionals are informed of the care plan and ask them to be involved in developing the plan.

The plan should include:

• the person’s functional goals following discharge
• a list of prescribed medication, including the dose, frequency and expected duration medication is to be taken. If an opioid has been started during the admission, outline the prescribing plan and include the potential weaning strategy as the pain resolves
• prevention and management strategies for potential medication side effects
• restrictions and precautions associated with prescribed medication, such as limitations on driving and work
• potential drug interactions between pre-hospital prescribed medication, over-the-counter medication and medications prescribed on discharge
• details of the person who should be contacted (by the patient or their family or carer) if pain relief on discharge is inadequate
• details of follow-up appointments or referrals for outpatient or community-based rehabilitation.

Share the plan

Give the older person and their family and carers a copy of the pain management discharge plan.

With the older person’s consent, and where appropriate, give a copy of the pain management discharge plan to their:

• GP
• residential aged care facility
• rehabilitation service
• community services.

Educate patients and carers

Older people and their family and carers should be educated about implementing the pain management discharge plan and the importance of maintaining adequate pain control on discharge.

Discuss ongoing pain control with the older person and their carers prior to discharge.

Medication information

Provide information about medication doses, how often the medications need to be taken and for how long, and how to deal with any side effects. Discuss the plan regarding a medication review and weaning strategy if improvement is expected. Encourage older people to request pain relief at the onset of pain.

Self-managing pain

Provide information on self-management interventions to reduce pain, including:

• energy conservation
• pacing activity
• work simplification techniques
• relaxation strategies and anxiety reduction.

Social engagement

Pain can increase the risk of social isolation. Help the older person to find ways of becoming or remaining as engaged as possible and include these strategies as part of their discharge plan.

Informing others

Remind older people to tell healthcare professionals about any pain they feel, where it is, the intensity and characteristics of the pain, activities that make pain better or worse, and how pain impacts on their daily routine (appetite, sleep, mood, mobility).

Managing chronic pain

Sometimes chronic pain cannot be relieved; however, the negative impact can be reduced. Give older people advice on how to deal with chronic pain. Share the following strategies.

• Find out as much as possible about the condition so you understand what is happening and don’t worry unnecessarily about the pain.
• Keep active and exercise gently, even though this may cause some discomfort. Discuss what options would be best with your doctor.
• Take steps to prevent or reduce depression and loneliness by any means that work for you, including talking to friends or health professionals.
• Think positively; identify and challenge negative thoughts you have in response to pain.
• Don’t let pain interfere with your life more than necessary – if you miss activities you used to do before the pain, try reintroducing them gradually and remember to pace yourself. Take pain medication before an activity that you know will aggravate your pain. You may need to cut back on activities if pain flares up, but you will be able to increase slowly again as you did before. Remember: pacing, planning and pre-emptive pain medication.
• Recognise that pain increases your risk of becoming socially isolated. Make an effort to stay engaged and involved with others and your community.
• Focus on finding enjoyable and fulfilling activities that don’t aggravate your pain.
• Seek advice on different types of coping strategies.
• Seek a referral to a pain clinic or chronic pain specialist or team if pain is ongoing.