ABSTRACT
Background: Postoperative pain should be closely monitored by regular scoring and documenting it as the 5th vital sign. Objective: To evaluate the use of a revised Graphic Sheet for recording pain scores as the 5th vital sign. Design: Descriptive study.Setting: Orthopedic surgical wards at Srinagarind Hospital, Khon Kaen University, Thailand.Methods: The sequences of the study included: 1) revision of the old record form; 2) orientation of the ward nurses on how to assess and to document pain scores; and 3) the new Graphic Sheet was tested for 1 month. Pain (at rest) was assessed by nurses 4- hourly along with the other four vital signs for at least 3 days on every patient. The assessment was excepted in patients younger than 10 years or whose hospital stay was shorter than 2 days.Outcome Measures: All recorded Graphic Sheets were audited. The value of pain scores were recorded each day and the number of patients with severe pain (score \> 7) noted. A questionnaire about using the Graphic Sheet was sent to each nurse involved in recording the pain scores for practicability study.Results: A total of 121 patients, 49 from Ward #1 and 72 from Ward # 2, were operated on during the study period. Sixty-seven percent of the patients had their pain scores recorded on the Graphic Sheet and these were done between 2 and 3 times per day. The number of patients with severe pain on postoperative day 0 and day 1 was 43 and 45 percent, respectively. Most of the nurses (95%) agreed that the Graphic Sheet was useful for documenting pain scores as the 5th vital sign and in daily practice.Conclusion: The revised Graphic Sheet for documenting pain scores was tested. The pain scores were documented in 67 percent of the patients. The Graphic Sheet was useful for postoperative pain management, therefore it should be promoted for use in the other surgical wards.
ABSTRACT
Background: Nursing care in the orthopedic surgical wards have in place a policy for quality improvement, which is emphasized by use of pain score recording.Objective: To audit pain score records for the first 72 hours after surgeryDesign: Descriptive study with retrospective data collectionSetting: Orthopedic Surgical Wards at Srinagarind Hospital, Khon Kaen University, ThailandMethods: Between March and April 2005, we extracted data from the Graphic Sheets for patients ³ 10 years of age.Outcome Measures: 1) All records were audited and the values for pain scores recorded each day including the operative day (Day 0 – assessed by a nurse every 4 hours) and two days post-op (Days 1 and 2 – assessed every 8 hours). Good quality records had regularly recorded pain scores. An improvement in quality was acknowledged if the proportion of quality records was ³80%. 2) The percentage of patients having two-consecutive severe pain recordings (i.e. score ³ 7) on each Day. 3) Mean pain score each time. 4) Patient-satisfaction before discharge.Results: A total of 94 patients were included. On Day 0, 98% of the assessment and recording of pain scores occurred, on Day 1 it was 95% and on Day 2 it was 89%. The highest post-operative pain was 5.5 ± 2.5, 4.0 ± 2.5 and 3.1 ± 2.7 on Day 0, 1 and 2; while the lowest pain score was 4.2 ± 2.8, 2.9 ± 2.7 and 2.1 ± 2.1 on Day 0, 1 and 2, respectively. Percentages of the patients having two-consecutive severe pain were 19%, 5% and 1%, respectively. All of the patients were satisfied with the pain relief offered.Conclusion: Completion of the assessment and pain score records at the orthopedic surgical wards were high and all of the patients indicated that they were satisfied with the pain service.Keywords: Audit Recording, Orthopedic Wards, Pain Scores, Postoperative