Making Pain Visible: An Audit and Review of Documentation to Improve the Use of Pain Assessment by Implementing Pain as the Fifth Vital Sign

doi:10.1016/j.pmn.2012.07.007

Pain Management Nursing

Volume 15, Issue 1, March 2014, Pages 137-142

https://doi.org/10.1016/j.pmn.2012.07.007 Get rights and content

Abstract

Pain has been promoted as the fifth vital sign for a decade, but there is little empirical evidence to suggest that doing so has affected the care of individuals suffering pain. This was a three-stage audit of pain assessment in one large teaching hospital in the Northwest of England. Stage one measured the baseline pain assessment activity on surgical and medical wards and identified that the pain assessment tool was not visible to nurses. Stage two redesigned the patient observation charts held at the end of the bed and piloted two versions for clinical utility. Version 2 which had pain assessment alongside the early warning score was adopted and introduced throughout the hospital. Stage three audited pain assessment and management 8 months after the introduction of the new charts. Pain was assessed more regularly at the stage three audit than at the baseline audit. On average, pain was assessed alongside other routine observations 70% of the time across surgical and medical wards. Medical wards appeared to improve their pain assessment using the philosophy of pain being the fifth vital sign better than surgical wards, because they assessed pain alongside routine observations in >90% of cases. Stage three identified that where a high pain score was recorded, analgesia was delivered in the majority of cases (88%). Introducing the philosophy of pain as the fifth vital sign and making pain assessment more visible on the patient observation chart improved the uptake of pain assessment. Pain management strategies were stimulated when high pain scores were identified.

Section snippets

Method

This was a three-stage audit designed by the nursing pain team to identify current pain assessment practice and to monitor the effects of introducing the principles of pain as the fifth vital sign. As the audit stages progressed, organizational learning occurred and led to the development of new observation charts and a short education program that assisted in implementing the new pain assessment philosophy. This learning led to adaptations of the final stage data collection owing to gaps

Stage One

All of the selected thirteen ward areas participated; however, the number of forms returned by each ward varied from 4 to 24. A total of 212 forms were returned, but 10 were only partially completed and were discarded, leaving a total of 202 patients included in the analysis. Almost one-half of the patients were postsurgical (88; 44%) or nonsurgical (99; 49%) with a small group of presurgical patients (15; 7%). Twelve patients (6%) were identified to have a chronic pain condition either as the

Discussion

Audit and practice development can go hand in hand. A new initiative to promote pain as the fifth vital sign was considered, but to judge its effectiveness, data were required from the times before and after the introduction of the initiative. The stage 1 audit identified that pain assessment within the hospital was rarely performed, but at this time it was thought that one potential reason for this lack of assessment was the visibility of the pain assessment tool. All pain assessment

Conclusion

Introducing the philosophy of making pain the fifth vital sign can affect nursing practice. Making the change, however, may require additional structural modifications, and the key may be the change process adopted. This may be influenced by the context of the change and would vary between organizations. It appears that improving the visibility of pain assessment increased its use and promoted pain management procedures.

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Poorly controlled pain in patients is related to several complications, such as increased nosocomial infections and mortality, where nurses play a crucial role.
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A total of 282 questionnaires were collected from those distributed among nurses working in medical, surgical, oncological, and intensive care services. The average score obtained on pain-related knowledge and attitudes was 58.89%. We found significant differences (p < .001) between the KASRP score and the professional group score. There were no differences in final score based on academic level or age. Questions related to pharmacology resulted in low scores and did not discriminate between levels of knowledge, being considered difficult. We did not find items that allowed discriminating between levels of knowledge.
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Original ArticleMaking Pain Visible: An Audit and Review of Documentation to Improve the Use of Pain Assessment by Implementing Pain as the Fifth Vital Sign

Abstract

Section snippets

Method

Stage One

Discussion

Conclusion

Nursing Clinics of North America

British Journal of Anaesthesia

Regional Anesthesia & Pain Medicine

Journal of Pain

A comparison of pain rating scales by sampling from clinical trial data

Clinical Journal of Pain

Assessment of pain

British Journal of Anaesthesia

Pain—A persistent problem. The Labat Lecture

Regional Anaesthesia & Pain Medicine

Pain Standards

Pain management: The fifth vital sign

Healthcare Benchmarks

Original Article
Making Pain Visible: An Audit and Review of Documentation to Improve the Use of Pain Assessment by Implementing Pain as the Fifth Vital Sign