Abstract
BackgroundIn spite of advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the current practice must be understood.AimThe aim of this article was to evaluate pain assessment and management of patients in two surgical wards at a tertiary hospital in South Africa.SettingThe study was conducted within the Western Cape Province of South Africa in a government-funded tertiary academic institution. The patients at this hospital are generally from the low-income strata and live in resource-poor communities.MethodsA cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward of a tertiary hospital in South Africa over a span of 1 month were targeted for review. Medical folders that were not available or had missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan.ResultsA total of 168 folders were available for review. Nearly half of the patients had no documented pain assessment. The Verbal Rating Scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge of the practitioner and were not evidence-based.ConclusionPain assessment and management was a problem in the two wards reviewed, which is similar to the findings from studies referenced in this text. Health professionals must be empowered to manage pain adequately. An assessment tool that integrates the biopsychosocial factors that influence the pain experience should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.
Highlights
Pain is a subjective phenomenon defined by the International Association for the Study of Pain as an ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ (Merskey & Bogduk 1994)
While the reported results may be relevant elsewhere, they must be considered within the context. This audit suggests that pain assessment and management was a problem in the two wards reviewed at the tertiary http://www.hsag.org.za hospital
When a pain assessment was conducted, the ward doctor was at the forefront, departing from the nurse-based acute pain service model, which empowers nurses to manage pain in the wards (Rawal 1999)
Summary
Pain is a subjective phenomenon defined by the International Association for the Study of Pain as an ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ (Merskey & Bogduk 1994). It can be classified based on its time course as either acute or chronic. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards No such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the current practice must be understood
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