Medication administration / Giving medications

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Q: How do you use a pain scale?

To ensure that a pain scale is serving its intended purpose, it helps to understand how it works. A pain scale is used to help assess severity of pain. Only the person experiencing pain can know exactly what it feels like, but describing it with words or numbers helps other people, particularly health care providers, at least understand something about it. This then helps them assess whether they’re providing enough pain relief.

The most common pain scale asks you to describe the severity of your pain on a scale of 0 to 10. On this scale, “0" represents "no pain" and "10" represents "the worst possible pain." You’re not comparing your pain to anyone else's; you’re comparing how you feel with the worst you could ever imagine feeling. Of course, it depends somewhat on your past experience. If you’ve had extremely bad pain before, it influences how you rate pain that’s less intense. People who’ve not had very painful experiences have a different idea of the worst possible pain.

Health care providers who specialize in pain understand this. Your care provider doesn’t expect you to feel exactly the same as someone else who gives the same pain rating. If you say you have pain that is 9 out of 10, it’s understood to mean that the pain you feel is almost as bad as anything you could ever imagine. Very occasionally, people say their pain is 11 or 12 out of 10. This is understood to mean that they’re feeling worse than they could ever have imagined. On the other end of the scale, if you describe your pain as 2 out of 10, this lets your care team know that you have pain, but it’s far from being intolerable.

When you’re trying to assign a number to the pain you’re feeling, remember first what "0" and "10" mean. Then compare your current pain to what you would rate as the worst possible pain. Remember that the purpose of doing this is to give others an idea of how you’re feeling so they can treat your pain in the best possible way. There is no right or wrong answer; this simply is a communication tool to help others understand your experience.

Using a pain scale to rate the severity of your pain is only one part of assessing pain. It’s also important to let your health care team know what your pain feels like and where you feel it. Pain can feel different and can be described as stabbing, sharp, dull, burning, tingling or pressure. Different types of pain are treated differently. For example, additional medications are used for a pain that’s described as burning. If you suddenly have a new type or new location of pain, it’s vital to tell your health care team.

Q: What can be done with medications that are left over after someone dies, or with medications that aren’t being used any more?

It’s not a good idea to flush leftover medications down the toilet, as this pollutes the environment. It’s not a good idea either to keep medications at home, as this can be a safety issue.

It is a good idea to take leftover medications to a pharmacy, so someone there can dispose of the medications properly. Most pharmacies take leftover medications that you want to get rid of. A palliative or home care program in your area may have a procedure for disposing of leftover medications for you to follow.

Q: How should pain (fentanyl) medication patches be safely disposed of at home?

Fentanyl patches contain strong medication and are placed on the skin to help relieve pain. The patches should be applied and removed as ordered by the doctor and only on the person for whom they were prescribed.

Pain patches should not be placed in the garbage! There is still medication left in used patches when they are taken off the skin. Used and unused pain patches may cause harm or death to adults, children and pets if they are misused or used by accident. It is very important that you safely store and dispose of all the pain medication patches to avoid harm to others.

When your pain medication patch is due to be changed, remove it from the skin and fold it, pressing the sticky sides together. Immediately dispose of the patch by placing it in:

  • a large empty medicine bottle with a child-proof lid
  • a small lockbox (e.g. fishing tackle or tool box)
  • a medical waste bin called a ‘sharps container’ provided in some parts of Canada by pharmacies and hospitals

Label the container and place it in a safe place that is out of reach of children and pets. Return used patches to the pharmacy or hospital as soon as you are able.

In the past, health care professionals recommended flushing used pain patches down the toilet. Due to growing concerns about medicines in our waste and water systems, this is now discouraged particularly if you have a septic tank or field. Flushing pain patches down the toilet should only be done in situations where reuse, misuse, theft or abuse of the medication in patches is a concern, and it is clearly not possible to return used patches to the pharmacy or hospital within a safe period of time.

If the patches are no longer needed because the person has died or is no longer cared for at home, or if the person’s pain medications have been changed, return the patches to the local pharmacy or hospital as soon as possible.

Do not hesitate to ask your local pharmacist or health care team for advice on how to best dispose of your pain medication patches where you live.

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