Progress in achieving a pain free hospital

(2005-08-29)

It is an appealing and ambitious goal, but while the subject of pain free care in hospitals has been discussed at length over the years, there has been limited evaluation of how close we have come to achieving this ambition. As a consequence, a group of investigators in Germany led by J Osterbrink from the Hospital of Nuremberg developed a quasi-experimental design for a study that evaluated the quality of both process and outcome of pain therapy.

study was carried out across 5 separate hospitals and included the observation of 676 patients, 823 nurses and 394 doctors. As a part of the study (and not part of the standard care pathway), pain scores where taken from all the observed patients with 35% reporting moderate (>3 on a numeric rating scale - NRS) and 38% severe (>6 NRS) pain at rest. While the vast majority of surgical patients and nearly half all medical patients described pain at some point during the study, only 43% chronic patients and 18% of acute patients received any kind of analgesic medication. Of the nurses and physicians caring for these patients, 65% described no need to change methods of pain management.

The trigger factors described by patients for severe pain were all predictable and scheduled - moving position (40%), removal of drains (18%) and physiotherapy (28%) - yet there was no pre-emptive analgesia provided. The evaluation also recorded inadequate cooperation between physicians and nurses which hindered effective treatment and, unsurprisingly, 72% of those patients whose pain was inadequately managed, later made negative comments about the hospital.

These findings are now being used to develop new interventions and protocols for each institution which will hopefully address the deficiencies identified so far and take us a step closer to a standard of care that allows patients to be genuinely free from pain.

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