The Treatment of Patients with Moderate to Severe Pain in the Recovery Room Using the Pain Algorithm

Background : Postoperative pain remains a common complaint among PACU patients so we developed guidelines for better pain control. Patients rated their pain using a numeric rating scale (NRS, from 0 to 10). According to the guidelines, PACU nurses knew that patients with a NRS score  were in severe pain and required medication.Objective : To determine the proportion of patients not receiving treatment according to the guidelines.Design : Descriptive studySetting : PACU at Srinagarind HospitalSubjects : April 2001 PACU recordsMeasurement : The PACU records were reviewed retrospectively for age, NRS score, sedation score, number of treatments given and types of medication used.Results : the PACU admitted 474 patients in the month of April and 338 them were included in our study. Pain assessment was performed on 246 of the sample (72.8%,95%Cl : 68-77%) although 92 were not documented. Most of the patients (95.5%) were able to rate their pain using the NRS. NRS scores  5 were reported by 156 patients (66.4%,95%Cl: 60-72%) but 40 of them (25.6%,95%Cl: 19-33%) did not receive any treatment because 10 refused it and 30 gave no outward sign of needing it. Prior to discharge, 54 patients (29.8%, 95% Cl: 23-37%) still had NRS score5.Conclusion : Pain assessment according to the guidelines was performed on 72.8% of the sample. About 60% of patients had a NRS score  5 but 25.6% did not receive any treatment. We concluded that the guidelines were useful for PACU pain management. For greater improvement in the quality of PACU care, a prospective study should determind provider compliance.Keywords:\ 1. Postoperative Pain\ \ 2. PACU\ \ 3. Pain algorithm