An Evaluation of Pain Score Record Form as the Fifth Vital Sign for Postoperative Cares of Orthopedic Patients

Abstract

Background: Postoperative pain should be closely monitored by regular scoring and documenting it as the 5th vital sign.

Objective: To evaluate the use of a revised Graphic Sheet for recording pain scores as the 5th vital sign.    

Design: Descriptive study.

Setting: Orthopedic surgical wards at Srinagarind Hospital, Khon Kaen University, Thailand.

Methods: The sequences of the study included:  1) revision of the old record form; 2) orientation of the ward nurses on how to assess and to document pain scores; and 3) the new Graphic Sheet was tested for 1 month. Pain (at rest) was assessed by nurses 4- hourly along with the other four vital signs for at least 3 days on every patient. The assessment was excepted in patients younger than 10 years or whose hospital stay was shorter than 2 days.

Outcome Measures: All recorded Graphic Sheets were audited.  The value of pain scores were recorded each day and the number of  patients with severe pain (score  > 7) noted. A questionnaire about  using the Graphic Sheet was sent to each nurse involved in recording the pain scores for practicability study.

Results: A total of 121 patients, 49 from Ward #1 and 72 from Ward # 2, were operated on during the study period. Sixty-seven percent of the patients had their pain scores recorded on the Graphic Sheet and these were done between 2 and 3 times per day. The number of patients with severe pain on postoperative day 0 and day 1 was 43 and 45 percent, respectively.  Most of the nurses (95%) agreed that the Graphic Sheet was useful  for documenting pain scores as the 5th vital sign and in daily practice.

Conclusion: The revised Graphic Sheet for documenting pain scores was tested. The pain scores were documented in 67 percent of the patients. The Graphic Sheet was useful for postoperative pain management, therefore it should be promoted for use in the other surgical wards.

Key words: pain score, 5th vital sign, orthopedic patients, postoperative care