Tip of the month

Assess pain in all patients

Do you only assess patients for pain if they respond "yes," when asked if they’re having pain? Although this criteria might seem like common sense, it’s a mistake, according to Christine Tarver, MS, RN, CNS, a clinical nurse specialist at El Camino Hospital in Mountain View, CA, and co-chair of the hospital’s pain management committee.

When the hospital did a patient pain survey, patients were asked, "Are you currently having pain?" Even if the patient stated "no," the next question asks them to rate their pain on a scale of 0-10. The results were surprising: "Half of the patients said "no," they weren’t having pain; however, of 44% of those patients then gave a rating above zero — as high as seven," reports Tarver.

Based on this finding, ED staff now ask for a pain rating using the 0-10 numeric scale for all patients. The question "Are you having pain?" which requires patients to answer yes or no, is skipped. "We simply ask patients their pain levels," explains Tarver. "If we had stopped at the no’ response, we would have missed 25% of our patients in pain."

Asking pain level for all patients is the best practice, says Tarver. "In addition, we had our mock surveyors here to prepare us for our Joint Commission survey, and they reinforced that relying on a yes/no response to assess pain is not sufficient," she notes. "Levels need to be documented, even if the level is zero."

[Editor’s note: For more information, contact: Christine Tarver, MS, RN, CNS, El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040. Telephone: (650) 988-7596. E-mail: Chris_Tarver@elcaminohospital.org.]