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A Quality Improvement Approach To Determine the Intensity of Pain in Hospitalized Patients



A Quality Improvement Approach To Determine the Intensity of Pain in Hospitalized Patients



Anesthesiology Abstracts of Scientific Papers Annual Meeting: Abstract No. A-934



Introduction: Moderate to severe pain continues to be unrelieved in hospitalized patients. Reported incidence is 80% for adults1and 49% for children2. In the pediatric oncology patient population, the nature of the problem is not well described. Therefore, our Pain Management Service asked the question, "What percentage of inpatients have significant pain and is it treated effectively in any one day?" Method: Over a 18 month period, chart reviews were done for all inpatients hospitalized for at least 24 hours to determine: 1) was the pain assessed every four hours (as per policy)? 2) how many patients have significant pain? and 3) was the significant pain treated effectively? Dates of chart reviews were chosen randomly. None-to-moderate pain was defined as ltoreq 4 using the Faces Pain Scale 3 or FLACC 4. Significant pain was defined as > 4 using the same scales. Effective management was defined as any intervention resulting in a pain score ltoreq 4 when reassessment was done one hour following an intervention to reduce the pain. Intervention was defined as pharmacological or nonpharmacological treatment known for its analgesic properties. Results: Out of a total of 844 charts, a mean of 43 charts were reviewed per day with a range of 15 to 89. On average charts were reviewed on two random days per month. Major findings are: 1) initially only 66% of patients had their pain assessed according to hospital policy (every four hours while awake) that improved over 18 months to 80.9% (min, 62.5%, max 92.0%), 2) an average of 33 patients (low 12, high 72) had mild to moderate pain on any day, 3) 9 patients (low 1, high 27) had severe pain, 4) of those with severe pain, on average severe pain was relieved in 6 (low 1 high 18) or 66.7%, 5) of those with severe pain, an average of one patient with severe pain was not relieved with intervention or 11.1% (low 0, high 7), 6) of those with severe pain, on average 1 patient had no intervention offered or 11.1% (low 0, high 3), and 7) no reassessment one hour after an intervention to reduce the severe pain occurred in 2 patients, (low 0, high 9) or in 22.2% of the charts reviewed.).

Accession: 034279366

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