Pain service sheet audit

Conducted in the month of April 2012 and repeat Audit in January 2013

This was adapted from the Victorian Quality Council (VQC), Acute Pain Management

Measurement Toolkit (‘the toolkit’). The toolkit aims to provide a range of validated

measurement tools appropriate to the diverse needs of pain assessment.

2012 2013

Total epidurals

41 48

Total PCA morphine

11 17

Total nerve blocks

7 17

Total intra- articular shoulder - LA

3 1

Total 62 82

Clinical practice audit

2012 2013

Patient received a pain assessment as indicated in the protocol?

97% (3% PAPER NOT IN FOLLOW-UP FOLDER)

90% (10% PATIENT PAPER NOT IN FOLDER)

Patient was followed up at least 2 times in 24 hours

90% ( Single visit- 4/62; no visit- 2/62)

90% (4/82- single visit; 5/82- no visit)

Has a pain assessment tool been utilised? 100% 100%

Is there evidence that there were consecutive scores of 7/10 or more?

16% 4.8%

Is there evidence of intervention when this has occurred?

100% 100%

Is there evidence of consecutive sedation scores of 2 or more?

0 0

Is there evidence of intervention when this has occurred?

N.A N.A

Is there evidence of any other reportable observation? Nausea, vomiting, hypotension etc

Yes, YES

Is there evidence of interventions in response to the other reportable observations?

100% 100%

Data entry in pain service sheet

Patient name 100% 100%

Age 100% 100%

Medical problem 95% 100%

Name of block 70% 100%

File number 92% 100%

Premature catheter dislodgement 13%; 7% -epidural;40%- nv.blk,

3.6%; 1.2% epidural;2.4% nv blk

Problem area identified in 2012

1. Pain service follow up sheet, not filled and put in the collection box in the recovery

2. High percentage of “2 consecutively high pain scores”. Immediate rescue analgesics are

given for high pain score but follow up not done after 30 min, fixed time for rounds, and

reliance on ward staff for feedback. Missed cases of analgesia failure.

3. High dislodgement rate

4. Deficient data in the follow up sheets related to name of nerve block and medical

problems

Solution suggested in 2012

1. Encourage colleagues to fill the chart and put in the collection box, the doctor posted in

the recovery, during the morning hours confirms the chart is written.

2. Follow up of patients with high initial pain scores after 30 min to 1 hour.

3. Better fixation, tunneling of catheters

4. Information sessions for colleagues on the importance of filling the charts properly, for

example a chart with information about allergies or co morbid conditions will help the

pain service in adding co analgesics or rescue medications.

Repeat Audit 2013

1. Marked improvement in certain parameters like chart filling up by anesthetists, was

observed

2. Dislodgement rate decreased due to better fixation

3. Lower pain scores and no cases with high (7/10) pain scores

4. Increase in papers not found in the follow up box.

Solution suggested in 2013

Create awareness amongst anesthetist and technician about keeping the paper in the

box (better follow up of patients, patient safety and early detection of complication if

case followed up).

Conducted by Dr Farah Jafri