Pain and Sedation
Improving Pain and Sedation Assessment and Documentation
Carolyn Moran, DNP, RN, AGACNP and Melissa Browning, DNP, APRN, CCNS
At Rush University Medical Center, nurses were not consistently using proper pain and sedation scales throughout a patient’s hospital stay. The purpose of this project was to improve and simplify the process of assessing and documenting pain and sedation for the nurses who care for adult patients.
The purpose of the previously used pain scales was explored by the Pain and Sedation Task Force, changes were appropriately made, and the electronic medical record (EMR) options for pain control were simplified.
At the start of this project, there were seven pain scales and three sedation scales, including the Defense and Veterans Pain Rating Scale (DVPRS). The change involved limiting the selection to two scales, the DVPRS for patients who are able to report pain and a new scale, the Critical Care Pain Observation Tool (CPOT), for patients who are not able to self-report pain. The sedation scales were simplified to two scales, the RASS and the POSS.
Before implementation, the CPOT was pilot tested on four different units. Education was then provided to nurses in adult units. Education included proper pain and sedation scale utilization and the elements of a proper pain assessment with case studies. The go-live date in the EMR was Oct. 4, 2016.
Before project implementation, the nurses were documenting the correct pain scale 44.7 percent of the time. Post-implementation audits indicated that nurses selected and used the correct pain scale 96.9 percent of the time. The results indicate that reduction and reform of the pain scales lead to more accurate assessment of patient pain.