Implementation of Pain Assessment Tools Using Audit and Feedback Strategy
Various assessment strategies for pain are needed in order to provide qualitative and
quantitative information because pain is both a sensory and emotional experience.
Qualitative assessment refers to the location, duration and characteristics of the pain,
while quantitative assessment refers to the evaluation of pain intensity by way of
a pain scale. Pain control interventions should be timely, comprehensive and
coordinated.[1]
Quantitative pain assessment scales provide reliable measures of pain intensity
and can aid in pain management and be easily implemented in an outpatient setting.
Routine pain assessment is sustainable over time and its recording of results allows
regular reassessment of outpatients.[2]
The recommended best practice for assessment and management of pain include:[3]
The daily screening of all persons at risk for pain based on self-reports and care
provider reports.
The selection of the pain assessment tool for the patient to assess the parameters of
pain such as its location, its effect on daily living functions, the medication usage, the
quality of pain and the precipitating factors of pain.
The formation of a plan for the pain management of a patient in collaboration with an
interdisciplinary team.
The selection of the appropriate individualized analgesics to be administered to the
patient.
The monitoring of a patient’s analgesic medication for any side effects.
The documentation of all pharmacological interventions in a patient’s pain record.
The best available evidence should guide the best practice of pain assessment.[4]
The recommended grades based on the required strength of the evidence are as
follows:[5]
A – requires the inclusion of at least one randomized trial
B – requires the conduct of clinical studies without randomized trial
C – requires evidence from experts’ reports or opinions and/or
clinical experiences.
In the implementation of pain assessment tools, the following can be used a guide:[6]
A model of behavior change can be used to develop the strategies for implementation.
A combination of strategies can be used to influence practice change because no one
intervention works in all cases.
The organizational environment has to be considered in designing implementation
strategies.
The validated tools for quantitative pain assessment include the following:[7]
The Visual Analogue Scale (VAS), which provides for the indication of pain intensity on
a 10 cm. line with no pain and pain as bad as it could possibly be on opposite ends.
The Numeric Rating Scale (NRS), which provides for the rating of pain on a 0 to 10
scale.
The Verbal Rating Scale (VRS), which provides for the indication of pain using verbal
descriptions on a scale from no pain to worst possible pain.
Facial Grimace & Behavior Checklist Flowcharts, which provide facial expression
illustrations and behavior descriptions for the scoring of levels of pain.
[1] “Assessment of Pain”, Cancer Pain Management in Children, 1994,
<http://www.childcancerpain.org/frameset.cfm?content=assess01> [accessed 27 April 2011]
[2] Deborah J. Rhodes et al, “Feasibility of Quantitative Pain Assessment in Outpatient Oncology
Practice”, Journal of Clinical Oncology, 2001, <http://jco.ascopubs.org/content/19/2/501.full>
[accessed 27 April 2011]
[3] “Assessment & Management of Pain”, Nursing Best Practice Guideline, 2007,
<http://ltctoolkit.rnao.ca/sites/ltc/files/resources/pain/RNAOBPG_Pain_and_Supp.pdf>
[accessed 27 April 2011]
[4] ibid
[5] ibid
[6] ibid
[7] “Appendix E: Tools for Assessment of Pain”, Nursing Best Practice Guideline, 2000,
<http://ltctoolkit.rnao.ca/sites/ltc/files/resources/pressure_ulcer/AssessmentTools/RNAO_pg83t84_ToolsPainA.pdf> [accessed 27 April 2011]
Credit:ivythesis.typepad.com
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