Atkinson Victoria J, Almahdi Basil
Department of Anaesthesia, Whittington Hospital, London, UK ; Department of Anaesthesia, Frimley Park Hospital, Surrey, UK.
Department of Anaesthesia, Whittington Hospital, London, UK.
Br J Pain. 2014 May;8(2):78-83. doi: 10.1177/2049463713510288.
Accurate assessment of pain is associated with improved pain management, which can lead to better patient outcomes. It has been recommended that all patients have their pain assessed and the scores documented as the 'fifth vital sign'.
All inpatients in the medical and surgical wards in our hospital were asked directly to score their pain according to the hospital-wide scoring system. Their observation charts and drug charts were then reviewed in order to determine the accuracy of documented pain assessments and the subsequent analgesic management.
Of the 208 patients reviewed, 20 (15%) patients on medical wards and 26 (38%) patients on surgical wards were in moderate to severe pain. Documentation of pain scores was not universal, with 29 (14%) patients having no score documented with their last set of observations. Of those with a score recorded, it was not found to correlate with the scores reported on direct questioning in 41% of medical patients and 71% of surgical patients. Provision of analgesia was also found to differ between medical and surgical wards.
The care of pain in the wards falls below the standards set by the Royal College of Anaesthetists. It is necessary to undertake a programme of education to increase awareness of the problem and to improve assessment and management to enhance the patient experience.
准确评估疼痛与改善疼痛管理相关，这可带来更好的患者预后。建议对所有患者进行疼痛评估，并将评分记录为“第五生命体征”。
直接要求我院内科和外科病房的所有住院患者根据全院评分系统对其疼痛进行评分。然后查阅他们的观察图表和药物图表，以确定记录的疼痛评估的准确性以及随后的镇痛管理情况。
在接受审查的208名患者中，内科病房有20名（15%）患者以及外科病房有26名（38%）患者处于中度至重度疼痛。疼痛评分记录并不普遍，29名（14%）患者在最后一组观察记录中没有记录评分。在有记录评分的患者中，发现41%的内科患者和71%的外科患者的记录评分与直接询问时报告的评分不相关。还发现内科和外科病房在镇痛措施的提供方面存在差异。
病房中的疼痛护理未达到皇家麻醉师学院设定的标准。有必要开展一项教育计划，以提高对该问题的认识，并改善评估和管理，以提升患者体验。
