Presentations for STAPG Prize

An audit to evaluate the effectiveness of an opioid dosing algorithm on postoperative pain scores
Ms Nicola Bourne

Biography
Nicola has been a clinical nurse specialist in the pain service at Imperial College Healthcare Trust, since 2003. Previously she worked in the Intensive Care Unit at Chelsea and Westminster Hospital and trained at the John Radcliffe Hospital in Oxford.  She is an active member of the London RCN and Pain Network Group. Her special interests include managing acute pain in opioid dependant patients.

Abstract

Introduction
The aim of this two part prospective audit was to evaluate whether the introduction of a pre-printed prescription and prn opioid dosing algorithm improved pain scores on a surgical ward.  The primary aim of both audits was to examine pain intensity following various surgical procedures in those patients not normally seen by the pain service.  The secondary measures were to investigate how often pain was assessed by nursing and medical staff and to explore prescribing practices for analgesia. 

Methods
A convenience sample of 58 patients took part in the exploratory audit.  Patients, who had undergone all types of surgery, were eligible to participate.  A questionnaire was developed covering the following areas: pain assessment, pain intensity at rest, pain intensity on movement, worst pain in the previous 24 hours and prescribed analgesia.  A categorical pain scoring scale was used.  Patients were audited against standards for pain assessment, pain intensity and prescribed analgesia.

A pre-printed prescription and prn opioid dosing algorithm was introduced to the ward and intensive training was provided.  After this change of practice was implemented, a second follow-up audit was performed using a modified version of the original questionnaire.  A convenience sample of 42 patients took part in the audit.

Results
Due to the small numbers included in these audits, it is only possible to identify trends rather than significant differences.  The audit results show an improvement in the number of patients reporting severe or unbearable pain following the introduction of the opioid dosing algorithm.  Even though an improvement was found in pain scores, the standard set by the UK Audit Commission in 1997 was not met.  The most significant findings of the audit were an improvement in nurses’ assessment of pain and an improvement in the agreement between patients’ reported pain scores and those documented by the nurses

Discussion
The introduction of a pre-printed prescription and prn opioid algorithm improved pain scores on a surgical ward but further improvement is required to achieve set standards.  A significant improvement in nurses’ assessment of pain was also achieved.  The audit has highlighted that nurses are still reluctant to give prn analgesia to postoperative patients.  Additional strategies are therefore required to improve patients’ experience of postoperative pain.