Quality palliative care is important in ensuring the wellbeing of those suffering with a terminal illness. One of the primary roles of a palliative care-giver is to be able to make accurate pain assessments. Without sufficient training nurses will struggle to meet the many tough demands they meet. The Pain Audit Tools (PAT) are therefore useful in maintaining a high standard of care and allowing improvements to be made where necessary. It serves as both an educational tool and a quality assessment tool.
Author of Tool:
City of Hope Pain & Palliative Care Resource Center
Key references:
Ferrell, B, McCaffery, M., and Ropchan, R. (1992). Pain Management as a
Clinical Challenge for Nursing Administration. Nursing Outlook, 40(6), 263-268.
Primary use / Purpose:
The Pain Audit Tools (PAT) includes three separate surveys used for gathering information on pain management. The first is an 11-item audit form useful for obtaining basic information about the patient. The second is a 17-item, self-report, pain assessment to be filled out by the patient. Finally, the third survey is used for aiding surgical reviews.
Dear Colleague:
We appreciate your interest in the
Pain Audit Tools developed and used at the City of Hope Medical
Center. Attached for your information and use are three examples.
Example 1 is the Chart Audit Form. A few comments about the items are:
1. Item 3 identifies disease status based on our
oncology population. You may want to modify this to represent different
patient groups in your setting.
2. Items 8 & 9 identify how
pain is currently charted. For example, you might note that
the physician states
pain is mild; evening nurse states that
pain is better. No recordings on days or evening shifts.
3. Items 10 and 11 refer to follow-up evaluation. This is particularly useful since JCAHO looks at evaluation very closely.
Example 2 is the
Patient Interview Component of the audit. You may also need to modify this form based on your
patient population. We have found item 14 to be particularly helpful when compared to item 7 of the chart review form so that we can
contrast what
medication and dose is ordered for the
patient versus what they are actually taking. In each of these audits we have found that the patients are consuming only a fraction, generally approximately 50%, of the medicines that are prescribed. This points to our need to improve
compliance with medications already available in addition to ordering more appropriate medications.
Example 3 is a chart review form that was developed specifically for our Surgical Service. We have designated some specific surgeries to be reviewed. You may want to modify this based on the surgical procedures that you are interested in. This form serves as an example of modifying the audit to meet specific areas or
needs.
You may also find the following articles useful in your efforts to
conduct pain audits:
Betty Ferrell, Margo McCaffery, and Rebecca Ropchan. Pain Management as a Clinical Challenge for Nursing Administration. Nursing Outlook, 1992:40(6); 263-268.
You may also wish to contact the American
Pain Society for their QA guidelines (5700 Old Orchard Road, First Floor, Skokie IL 60077-1057, 708/966-5595).
We hope that these forms are useful to you. We have found auditing charts and doing
patient interviews is a very important component of
quality assurance to improve
pain management. We look forward to hearing about your efforts.
Sincerely,
Betty R. Ferrell, RN, PhD, FAAN Research Scientist
Nursing Research and Education
2/98
CHART AUDIT
Subject #
Medical Record #
Interviewer Initials
Date
3. Disease Status:
Cancer/Active Treatment
4. Current Treatments
Radiation Chemo Surgery Other (List)
6. Admitting Medical Service
Chart Review
7. What is currently prescribed for the
patient’s
pain?
|
|
When Started |
Dose |
Route |
Schedule |
8. Is there evidence of use of objective ratings (i.e. visual analogues, rating scales,
pain tools)?
No Yes
(If yes identify both the rater and rating, example: “0-5 rating scale in nurse’s notes”)
9. Documented descriptions of
pain other than objective ratings for the previous 24-hour period. If present, specify rater and description. (Example: “Physicians progress report says “
Pain better.”)
10. Has a follow-up evaluation been charted for:
Medications: Yes No Other Modalities Yes No
|
|
Yes |
No |
RN Notes-Last 24 Hrs Yes No |
|
RN Care Plan: |
Yes |
No |
MD H&P Yes No |
Last MD Progress Note: Yes No
Other: Yes No
Your comfort is very important to us. We would appreciate your input on the following
survey so that we might learn how to better relieve your
pain. Your answers to this
survey will remain confidential. Your
participation is completely
voluntary.
1. Your Age 2. Male Female
4. When was your
cancer first diagnosed? Month Year
5. When did your
pain first begin? Month Year
6. Who writes the prescriptions for your
pain medications? (List doctors’ names)
Please answer the following questions by circling the one number on each line that best describes your
pain or other symptoms.
7. How much
pain do you have right now?
8. Over the past 24 hours, what is the average amount of
pain you have had?
9. What is the worst amount of
pain you have had in the last week?
11. Do you have nausea?
12. Do you have a problem with drowsiness or sleepiness from your
medication?
0 1 2 3 4 5 6 7 8 9 10
Never All the Time
13. How satisfied are you overall with the current treatment you are receiving for your
pain?
0 1 2 3 4 5 6 7 8 9 10
Not At All Satisfied Very Satisfied
14. What medicines are you taking for
pain? Please list.
|
Name of Medicine |
How Much Is Ordered |
How Much Have You Taken In Last 24 Hours |
15. Which of the following influence or interfere with your
pain management? (Check all that apply.)
Money to pay for
pain medications.
Communicating or explaining your
pain to others.
Coming in to pick up prescriptions.
Being afraid of being addicted to
pain medicines.
Side effects of
pain medicine.
Concern that I should save some
pain medicine in case my
pain gets worse.
Other (Describe)
16. Are you seeing any specialists for help with your
pain? (Check any that apply.)
Radiation Other (Describe)
17. Are you using anything other than medicines for your
pain?
Heat Relaxation
Other (Describe)
Please write any other information you would like to share on the back of this
survey. Thank you for your help.
Medical Record # Pt. Completed Area Interviewed
CITY OF HOPE NATIONAL MEDICAL CENTER
Chart Review
METHODS: Nursing staff to complete on day of discharge.
4. Surgical procedures
Abdominal:
- Gastric, subtotal w/ bypass
- Gastric, total w/ bypass
- Gastric, other specify
- Colon, hemicolectomy w/ colostomy
- Colon, hemicolectomy w/ primary anastomosis
- Colon, other, specify
- Rectal, abdominal- perineal resection, w/ colostomy
- Rectal, abdominal- perineal w/low anastamosis
- Rectal, other, specify
- Pancreatic, whipple procedure
- Pancreatic, biopsy w/ bypass
- Pancreatic, other, specify
- Mastectomy
- Lumpectomy
- Axillary node dissection
Chart Review Medical Record #
Page 2 Pt. Completed Area Interviewed
Gynecologic:
- Ovarian, TAH/BSO
- Corpus uteri, TAH/BSO
- Cervix uteri, TAH/BSO
- Vulva, Radical vulvectomy
- Pelvic exenteration
- Other
Disease Status :
- Active treatment
- Remission
- Palliative
5. Date of surgery:
Wound infection
Other
9. Is there evidence of use of objective ratings (i.e. visual analogues, rating scales,
pain tools)?
No Yes Rater , rating
10. Are there documented descriptions of
pain other than objective ratings for the previous 24-hour period?
No Yes Rater
Description
DOCUMENTATION:
11. Has a follow-up evaluation been charted for: Medications: Yes No
Other modalities: Yes No
Chart Review Medical Record #
Page 3 Pt. Completed Area
Interviewed
RN
Admission/HX: Yes No RN Notes-Last 24 hrs Yes No RN Care plan: Yes No MD H&P Yes No Last MD progress Yes No Other: Yes No
13. Perioperative
pain medications:
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Location |
Date |
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Dose |
Route |
Taken |
Schedule |
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Pre-Op |
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OR |
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Recovery |
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ICU |
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Ward |
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Discharge Meds |
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Home Phone Follow-Up |
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