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Objective Clinical Assessment by Independent Service Identifies Significant Gaps in Pain Assessment and Control FREE TO VIEW

Amy Pate; William Raoofi; Pawel Szumicki; Akella Chendrasekhar
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Richmond University Medical Center, Staten Island, NY

Chest. 2014;146(4_MeetingAbstracts):535A. doi:10.1378/chest.1994597
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SESSION TITLE: Quality & Clinical Improvement Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Though pain is a highly subjective phenomenon, standardized measurements are necessary to ensure adequate analgesia. Our objective is to examine whether independent objective clinical assessment differs from existing provider-documented assessment of pain levels.

METHODS: We performed a retrospective study of randomly selected patients admitted to the trauma service at a 448-bed urban level-I trauma center over the course of December 2013 to January 2014. During this time period an independent team had performed pain assessments on these patients using an objective numeric scale, with zero being “no pain” and ten being “worst possible pain.” Medical records were reviewed for type of injury; objective pain level as documented on nursing, physician, and emergency department (ED) notes; objective pain level as documented by independent team; and analgesic treatment.

RESULTS: A total of 101 patients were included. Types of injury included fall (n=38), fall with fracture (n=21), motor vehicle collision (n=19), fracture (n=12), assault (n=8), and miscellaneous (n=3). The mean overall pain level as documented by the independent team was 4.35 ± 0.76; 36 patients reported no pain, seven patients reported mild pain (level 1-3), 17 patients reported moderate pain (level 4-6), 30 patients reported severe pain (level 7-9), and 11 patients reported experiencing worst possible pain (level 10). Pain assessment documentation was missing in 36.6% of ED notes (n=37), 31.1% of nursing notes (n=32), and 64.4% of physician notes (n=65). Mean pain level documented varied by ED (5.37 ± 0.85), nursing (1.98 ± 0.67), and physician (2.94 ± 0.96) notes. Analgesic treatment was comprised of morphine (n=23), oxycodone/acetaminophen (n=10), ibuprofen (n=10), acetaminophen (n=9), acetaminophen/codeine (n=2), ketorolac (n=3), or any combination thereof (n=41). Three patients did not receive analgesic medication.

CONCLUSIONS: Assessment of pain level was absent in over 30% of all clinical documentation, with physicians being the worst offenders. Despite receiving pain medication, 57.4% of patients reported experiencing moderate to excruciating pain on objective assessment. Further prospective research is necessary to examine the utility of these findings on a large-scale basis.

CLINICAL IMPLICATIONS: Utilization of an independent objective clinical assessment is valuable to ensure appropriate pain management.

DISCLOSURE: The following authors have nothing to disclose: Amy Pate, William Raoofi, Pawel Szumicki, Akella Chendrasekhar

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