13An Audit of Multi-Disciplinary Pain Assessments and Use of Analgesia in over 65 years Old Adults Post Hip Fracture Repair

Abstract

Background: Inadequate management of pain on orthopaedic wards can lead to adverse patient outcomes including; increased length of stay and overall deterioration. Effective pain assessment and management are important in preventing such outcomes. We conducted an audit in a University Teaching Hospital to examine our interdisciplinary pain assessment practices. We examined 1) the documentation of pain assessment by medical staff, nursing staff and physiotherapists 2) the current medications prescribed for patient pain 3) whether a pain management plan had been documented by the pharmacists. Methods: The population sampled were post-operative patients with hip fractures, over 65 years old and currently on an orthopaedic ward (n = 30). The tool used to interrogate our objectives was modified from the 'Pain Audit Tools' from City of Hope and Pain Palliative Resource Centre. The tool was first piloted outside of the orthopaedic wards and re-modified. Results: One-day post operatively: Medical Staff documented a pain assessment in 77% of cases with 20% of these using an objective rating. Nursing staff documented a pain assessment in 97% of cases with 82% of these using an objective rating. Physiotherapists documented a pain assessment in 35% of their first appointments with patients. 40% of these used objective ratings. Pain assessments decreased as patient's length of stay increased. Medications Prescribed (n = 30); 83% paracetamol; 76% OxyNorm PRN; 36% OxyContin; 56% additional pain medication. 70% of patients had evidence of a pain management plan charted in their pharmaceutical notes. Conclusion: Medical staff's documentation of pain assessments decreases as length of stay increases. Nurses are the most likely to document a pain assessment. Physiotherapy are the least likely to document a pain assessment. Our recommendations 1) Pain Assessment should be documented more frequently. 2) Objective Ratings should be documented more frequently 3) Pain management plans should be documented as close to 100% as possible.