VLSHPB

Abstract Background Effective pain assessment and management are important in preventing functional decline and increased length of stay post hip fracture. We conducted an audit in a University Teaching Hospital to examine our interdisciplinary approach to pain assessment. Methods Over three months we sampled patients with hip fracture, over 65y on an orthopaedic ward. The tool used was modified from the ‘Pain Audit Tools’ from City of Hope and Pain Palliative Resource Centre, previously piloted and used in audit. We examined 1) documentation of pain assessments by medical, nursing and physiotherapy staff 2) medications prescribed for pain 3) pain score during an ad hoc patient interview 4) if paracetamol dose was appropriately weight-adjusted. Results We included 20 patients, mean age 78.5y. 14/20 (70%) were female. Average post-operative days to assessment was 13.3 days. Only 2/20 (10%) were assessed pre-operatively, before physio input. Pain assessment: Medical Staff documented a pain assessment in 18/20 (90%), with 12/20 (60%) using an objective rating. Nursing staff documented a pain assessment in all 20 cases; all used an objective rating. Physiotherapists documented a pain assessment in 10/18 (60%) of their first assessments with patients, 40% (4/10) used objective ratings. 6/20 (30%) of patients reported a pain score >6/10 during ad hoc interview. Pain assessments decreased as length of stay increased. Medications Prescribed: Paracetamol 95% (19/20); OxyContin 40% (8/20); OxyNorm PRN; 60% (12/20). 9/20 (45%) patients received >2 PRN doses within 72h of assessment. 14/20 (70%) patients had weight documented, all of whom were on appropriately dosed paracetamol. Conclusion Documentation of pain assessments decreases throughout admission. Nurses are most likely, and physiotherapists least likely, to document pain assessments. Of those patients with documented weight, all were on weight-adjusted paracetamol dose. We recommend better use of objective pain assessments and improved weight documentation for important medication dose-adjustments.