A quality improvement project: improving the rates of pain assessment when altering analgesia on an older adult inpatient psychiatry ward

Background

The study was set in a 15-bed older adult psychiatry ward. Staff involved were doctors, ward manager, nurses and nursing associates.

Introduction

Overall pain assessment was poor due to the under-recognised importance of recording pain. The aim of this quality improvement project was to implement strategies to improve rates of pain assessment and assess for effective change.

Methods          

An initial review of patient records was done prior to intervention, recording when a pain assessment template used by the trust (Abbey pain scale) was documented using the following criteria:

1. within 24 hours before changing analgesia

2. the week following analgesia alteration

3. further pain assessment if the patient was scoring post-intervention

4. within the last week regardless of analgesia

Initially a flow chart was displayed forprescribers. For cycle two the flow chart was circulated amongst the nursing team and educational information was provided forassessing pain.

Results

One month after the initial intervention 66.6% had a pain assessment recorded within 24 hours before analgesia alteration. 0% had a pain assessment repeated after alteration and 0% had a pain assessment repeated if they were scoring. 66.6% had pain assessed within the week.

Two weeks after intervention for cycle 2, 0% had a pain assessment 24 hours prior to analgesia alteration, 67% had a pain score following analgesia. None required a repeated score due to non-scoring post-intervention. 71% had pain assessed within the week.

Conclusions

Increasing awareness of documenting pain improved some metrics. Cycle 1 showed improvement in assessment prior to analgesia alteration and cycle 2 showed an improvement in recording pain post analgesia. There was an incremental improvement in weekly assessment. The key learning is to brief interested parties early to ensure timely adoption of process into routine practice and expand the scope to general adult psychiatry wards.