QI in practice: Tools to assess pain

Pain can be considered the fifth vital sign. Its assessment and management are important in ensuring patient wellbeing and rehabilitation. As with the other vital signs, taking a consistent and effective assessment and acting on the assessment is a key skill of the nursing team caring for patients.

As a ward, we recognise that neuropathic pain can be particularly debilitating for our patients and therefore has additional significance within neurology. With this in mind, we decided to undertake a QI project. Pain, if not assessed and managed, can significantly impact on an individual’s rehabilitation and potentially increase their length of stay. On the ward we commonly see patients with neuropathic pain which has its own characteristics, often difficult to localise and described as tingling, burning or pins and needles. A proportion of the patients admitted to the ward will also have cognitive difficulties making assessing and treating pain more challenging. An outcome from our QI project was the creation of a toolbox. Using a set of documents we were able to develop them into tools which can be used to assess pain.

The toolkit consisted of:

Pain score cards

Rating level of pain can be useful because it helps to establish the severity of the pain. The Pain Score cards are easy to use, and a single rating scale avoids confusion and provides consistency (Gregory 2017). The Pain score cards have been used on the ward and placed by the patient’s bed for ease of access. The four cards are colour coded and numbered from 0-3 to reflect the severity of the pain.

The cards can be used with patients who have limited communication or cognitive problems. They can be shown to the patient each time you are discussing their pain. The cards are designed in different colours and with larger print to aid patients to recognise and understand their differing levels of pain. When using the cards they can also be arranged in a different order to ensure that patients report the same pain score by indicating the same colour card.

Visual cues cards

Patients who have communication difficulties may have problems describing their pain. Describing the pain to clinicians helps with assessing and understanding the type of pain the patient has. The visual cue cards are a tool for patients to describe their pain. The cards contain various pictures to represent different types of pain and gestures to go with the pictures, which also is a visual representation to help understanding.

Although the Pain Assessment Toolbox was developed for patients with neurological conditions the pains score and visual cue cards can be used with other patients to support clinicians in assessing patients’ pain to truly gain a better insight into the type, levels and symptoms of pain.