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Roswell Park’s Fifth Vital Sign Program Boosts Pain Assessment
Vol 10, No 8, Suppl 4 (August 2001)
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BUFFALO, NY—A pain intensity assessment program undertaken
at Roswell Park Cancer Institute has been successful in increasing staff
assessment of pain and in promoting optimal pain management. Reporting at
a poster session at the Oncology Nursing Society’s 26th Annual Congress,
Jacqueline L. Massey, RN, MS, assistant director of nursing, described the
development of the Center’s comprehensive program, known as the Fifth
Vital Sign.
The purpose of the Fifth Vital Sign program is to identify
patients in pain; adopt an age-appropriate, uniform approach to pain
assessment; establish pain management standards of care; educate patients
about the need to communicate with staff about their unrelieved pain;
enhance patient comfort and satisfaction; and reduce the incidence and
severity of patients’ pain.
Ms. Massey said that the Fifth Vital Sign program applies
to all Roswell Park staff members involved in direct patient care and is
administered by the Department of Anesthesiology and the Department of
Nursing. The program began in April 2000.
The effectiveness of the new pain assessment policy was
evaluated with a Fifth Vital Sign survey, which was conducted in June 2000
and again in December 2000 and March 2001. Survey results showed sometimes
dramatic increases in staff attention to pain assessment.
Sample questions and percentage of respondents currently
implementing the policy are:
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If pain is persistently 4 to 10 on the pain scale, is
the pain service or an MD called? In June of 2000, 80% of staff
members said yes; in December 2000, 83.3% said yes; in March 2001, 100%
said yes. |
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Are pain scores charted every 4 hours for 24 hours
for postoperative patients? In June 2000, 28.6% of the staff were
meeting this objective. By December 2000, the percentage had risen to
87%, and by March 2001, to 89.5%. |
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Are pain scores charted every 8 hours on the TPR
sheet? In June 2000, 25% were doing this; in December 2000,
compliance was 75%; and the institution had achieved 100% compliance by
March 2001. |
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Are pain scores documented every 4 hours if pain is
rated as 7 or greater? In June 2000, 33.3% of staff members were
doing this; in December 2000, the percentage was 94%; and in March 2001,
92.6% were meeting this objective. |
The pain assessment tools used were (1) a numerical pain
assessment ruler in which 0 means no pain, 1 to 3 represents mild pain, 4
to 6 denotes moderate pain, and 7 to 10 signifies severe pain; (2) the
seven faces scale; or (3) verbal assessments from a patient.
The new policies and procedures give special consideration
to assessing and managing pain in children, Ms. Massey said. Moreover,
they recognize the hysical, cognitive/emotional, and behavioral aspects of
pain in children and emphasize the importance of using age-appropriate
approaches to assessment.
The Fifth Vital Sign program is now conducting chart
reviews of pain management at discharge, she said. A discharge quality
assurance policy statement is being developed to help guide practitioners
in prescribing a pain management discharge plan.
The pending policy statement guidelines indicate that at
discharge, a patient’s pain should be 4 out of 10 or less. If the pain is
more severe, but the patient is otherwise able to be discharged, a pain
service attending physician or designee will formulate a pain management
discharge plan for the patient. The patient will be provided with
follow-up appointments for reassessment and adjustment of the plan, all of
which will be documented.
The interdisciplinary pain initiative task force meets
monthly to monitor the implementation of the Fifth Vital Sign program and
to ensure continued progress. The task force recognizes the need to
measure outcomes, measure the knowledge and attitudes of staff, and
identify barriers to pain management, Ms. Massey noted.
Based on the data gathered, improved procedures will be
implemented and assessed when needed. |
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