This document summarizes pain service audits conducted in 2012 and 2013 at a hospital. The 2012 audit found issues like incomplete pain assessment documentation, high pain scores without timely intervention, and high catheter dislodgement rates. Solutions proposed included encouraging complete documentation, following up on high pain scores sooner, and improving catheter fixation. The 2013 audit found improvements in some areas like documentation but also an increase in missing patient records. Continuing to emphasize proper documentation follow up was recommended.

1. Pain service sheet audit
Conducted in the month of April 2012 and repeat Audit in January 2013
This was adapted from the Victorian Quality Council (VQC), Acute Pain Management
Measurement Toolkit (‘the toolkit’). The toolkit aims to provide a range of validated
measurement tools appropriate to the diverse needs of pain assessment.
2012 2013
Total epidurals 41 48
Total PCA morphine 11 17
Total nerve blocks 7 17
Total intra- articular
shoulder - LA
3 1
Total 62 82
Clinical practice audit 2012 2013
Patient received a pain assessment as
indicated in the protocol?
97% (3% PAPER NOT IN
FOLLOW-UP FOLDER)
90% (10% PATIENT
PAPER NOT IN
FOLDER)
Patient was followed up at least 2 times in
24 hours
90% ( Single visit- 4/62;
no visit- 2/62)
90% (4/82- single visit;
5/82- no visit)
Has a pain assessment tool been utilised? 100% 100%
Is there evidence that there were
consecutive scores of 7/10 or more?
16% 4.8%
Is there evidence of intervention when this
has occurred?
100% 100%
Is there evidence of consecutive sedation
scores of 2 or more?
0 0

2. Is there evidence of intervention when this
has occurred?
N.A N.A
Is there evidence of any other reportable
observation? Nausea, vomiting,
hypotension etc
Yes, YES
Is there evidence of interventions in
response to the other reportable
observations?
100% 100%
Data entry in pain service sheet
Patient name 100% 100%
Age 100% 100%
Medical problem 95% 100%
Name of block 70% 100%
File number 92% 100%
Premature catheter dislodgement 13%; 7% -epidural;40%-
nv.blk,
3.6%; 1.2%
epidural;2.4% nv blk
Problem area identified in 2012
1. Pain service follow up sheet, not filled and put in the collection box in the recovery
2. High percentage of “2 consecutively high pain scores”. Immediate rescue analgesics are
given for high pain score but follow up not done after 30 min, fixed time for rounds, and
reliance on ward staff for feedback. Missed cases of analgesia failure.
3. High dislodgement rate
4. Deficient data in the follow up sheets related to name of nerve block and medical
problems
Solution suggested in 2012
1. Encourage colleagues to fill the chart and put in the collection box, the doctor posted in
the recovery, during the morning hours confirms the chart is written.
2. Follow up of patients with high initial pain scores after 30 min to 1 hour.
3. Better fixation, tunneling of catheters
4. Information sessions for colleagues on the importance of filling the charts properly, for
example a chart with information about allergies or co morbid conditions will help the
pain service in adding co analgesics or rescue medications.
Repeat Audit 2013
1. Marked improvement in certain parameters like chart filling up by anesthetists, was
observed

3. 2. Dislodgement rate decreased due to better fixation
3. Lower pain scores and no cases with high (7/10) pain scores
4. Increase in papers not found in the follow up box.
Solution suggested in 2013
Create awareness amongst anesthetist and technician about keeping the paper in the
box (better follow up of patients, patient safety and early detection of complication if
case followed up).
Conducted by Dr Farah Jafri