Pain Reassessment Analysis

Institutional policy requires pain reassessment and documentation within 60 minutes of administering pain medication; but nursing adherence to this standard-of-practice is only
47% (Osterbrink, J., 2014). Pain is defined by the patient and can be experienced and expressed in multiple ways. Pain reassessments are crucial in providing patient satisfaction with their medical care. Our PICO question asks, “Among hospitalized adults with pain, how do different pain reassessments versus lack of reassessments impact pain control?” The University of Michigan provides guidelines for timing and assessment of pain. However, multiple research articles show that proper guidelines were not being utilized in clinical care. Research findings show sufficient
evidence of sound quality and consistency to demand a change in pain reassessment practice. In accordance to the clinical guidelines, University of Michigan has a protocol for pain reassessments. Pain must be assessed daily, upon transfer from one unit to another, following a surgical procedure, and before/after ambulating. Pain assessments must also include onset, location, duration, characteristics, aggravating factors, relieving factors and treatment. Pain reassessments must include pain relief score after pain medication is administered and nurses must also reassess pain at an appropriate time. Additionally, patients are able to sleep through one assessment (Pain management Steering Committee; Office of Clinical Affairs, 2015). Upon research, we discovered that many nurses did not follow standard protocol when assessing and reassessing patients’ pain, which calls for a change in clinical practice. After thorough research with the databases and narrowing our results, four articles were found that were applicable to our PICO question.
According to, Osterbrink, J. (2014), gaps between actual practice and evidence-based standard was found. Written reassessment schedules were not present in the various facilities and pain reassessments were not conducted on a consistent basis. In addition, observational tools for the cognitively impaired patients were missing in most facilities. This study was a convenience sample, therefore it was not very representative. Nonresponders were due to high workload, failure to see participation as beneficial, and participation was on a voluntary basis. Pain and pain location was not assessed routinely every four hours according to Herr, K. (2004). Additionally, pain reassessments after an intervention was not routinely assessed. In conclusion, nurses identified a difficulty in communicating as the greatest challenge in treating pain. The use of an auditory cue reminds nurses to perform and implement an intervention. According to Beaver, C. (2015), the results of using an auditory cue displayed an increase in patient reassessments from 47% to 93.5% compliance. This increase resulted in overall patient satisfaction. The National Guideline Clearinghouse, (2016), promotes an improvement in the quality of care and to serve as a foundation for practice. Research calls for a “regular and systemic” pain assessment. Our overall research proves that there is an issue with pain reassessments and that there are possibilities to narrow the gap and to improve the nurse and patient relationship in order to satisfy quality of
care.
From evidence in our research, a critical need for a change in practice regarding pain reassessments is proven to be true. Pain reassessments need to be done on all patients in a hospital setting, regardless of previous pain status. Especially patients who are receiving any type of pain medications, considering pain is the fifth vital sign frequently charted by the nursing staff. In addition to that, being timely with pain assessments and reassessments is crucial. Performing pain reassessments within 30-60 minutes of giving an oral medication and almost immediately to 15-30 minutes of giving an IV push medication is important in regards to properly controlling patient pain. Using open ended questions when asking patients about pain can help implement pain reassessments because this way we can gather more information from the patient. Also, making it a hospital wide policy to complete a pain reassessment for every intervention given by the nurse can help enforce this critical change. Another implementation strategy can be having a presentation to every floor hospital wide on the importance of pain reassessments to all health care professionals and not just nurses, considering nurse aides, nurse practitioners and doctors are also assessing pain.
In conclusion, the necessity for clinical changes with pain reassessments is demanded due to results of poor practice in clinical research. The University of Michigan guidelines outline the proper procedures that should be taken. Our research show that many nurses in clinical practice were not following similar guidelines required in their workplace, and pain reassessments were not completed properly or in a timely manner. Implementation of this change is mandatory, and can be done through presentations or electronic reminders. Patient-care is the basis of our career, how else can we assess our job performance if we don’t reassess our patients’ well-being through pain reassessments?