Quality Improvement Project Assessment of PAIN in Acute and Frailty Geriatrics in-patients at a district Hospital in South Wales

Introduction 

Pain is a common yet under-recognised and debilitating symptom among elderly patients, particularly with dementia, cognitive impairment, or communication barriers. Inadequate assessment can result in adverse outcomes, including reduced mobility, falls, and prolonged hospitalisation. This Quality Improvement Project aims to improve compliance with pain assessment and documentation on acute and frailty geriatric wards. At our hospital, a gap in systematic pain assessment was identified, hence we sought to address this by implementing standardized protocols, enhancing timely recognition, effective management, and overall quality of care.

Methods 

A retrospective review of medical notes from 20 patients admitted to the long-stay COTE ward assessed pain inquiry and documentation during the first three days of admission to the Frailty and Acute Geriatric wards, including site, severity, and collateral history. Targeted interventions, such as teaching structured pain assessment, ward posters reinforcing documentation, collateral history prompts, and visual tools for patients with dementia or language barriers, were introduced. Data was re-collected after four weeks and compared with the initial cycle. 

Results 

Pain assessment improved from 35% to 75% and site documentation from 86% to 100% when pain was present. Severity assessment showed little change (14% to 16%) and collateral history remained unchanged. However, severity assessment remained poor, underscoring the need for a more systematic approach that includes less commonly assessed sites such as the back and arms. Staff attrition during the August changeover highlighted the need for ongoing teaching and reinforcement of pain protocols for new doctors. 

Conclusion 

The first cycle showed inconsistent documentation, while the second demonstrated improved pain enquiry and complete site documentation. A doctor survey confirmed earlier pain identification, underscoring the importance of standardising this process to optimise recognition, management, and outcomes in this vulnerable population. Targeted teaching and ward posters further strengthened routine pain assessment, raising awareness and supporting patient-centred care.