Background Numerous national and local key policy drivers inform practice regarding pain assessment (NICE, 2018; WHO, 2020). However, consensus on the most effective pain assessment tool within palliative care is lacking (Hjermstad, Gibbins, Haugen, et al., 2008. Palliat Med. 22: 895). A baseline audit highlighted pain assessment was occurring but a standardised approach was required in May 2021.
Aims The aims of the project were; to increase the frequency and quality of documented pain assessments for patients admitted to the hospice and to increase confidence of nursing staff to follow a structured pain assessment tool.
Methods A hospice pain assessment tool was developed incorporating elements of the Brief Pain Inventory (Caraceni, Cherny, Fainsinger, et al., 2002. J Pain Symptom Manage, 23: 239) and the PQRST mnemonic. Electronic templates and bedside charts were created to enable accurate recording. An education programme consisting of a video and poster presentation were implemented to support this. The assessment tool was piloted on the in-patient unit with plans to roll out across all services following a period of evaluation. Pre- and post- implementation audits enabled review of the effectiveness of the project.
Results A pre-implementation audit highlighted that pain assessments were being conducted, however, the quality of these was varied. Mid-point and end of pilot audits identified that 100% of sampled patients were now undergoing a thorough pain assessment with comprehensive documentation on a regular basis. Nurses reported increased confidence in pain assessment methods, the medical team utilised the pain assessments to aid clinical decision making and patients reported feeling that their pain management was important to the team.
Conclusions The implementation of an adapted pain assessment tool has proven beneficial for both patients and professionals. It has also enabled the hospice to evidence alignment with best practice. The well planned, evidence based, targeted approach to managing the project has encouraged buy-in from the teams, resulting in successful implementation.
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