Patient monitoring part 3: pain assessment

Pain is the five vital sign which we, emergency nurses monitor the patient before, intra and post treatment. 

PQRST Method Facilitates Accurate Pain Assessment

"Nurses can help patients more accurately report their pain by using these very specific “PQRST” assessment questions":

P = Provocation/Palliation 

What where you doing when the pain started? What caused it? What makes it better? Worse? What seems to trigger it? Stress? Position? Certain activities? 

What relieves it?  Medications, massage, heat/cold, changing position, being active, resting? 

What aggravates it?  Movement, bending, lying down, walking, standing?

Q = Quality/Quantity

 What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or stretching.

R = Region/Radiation

Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves around?  Did it start elsewhere and is now localized to one spot?

S = Severity Scale

How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?

T – Timing

When/at what time did the pain start? How long did it last? How often does it occur: hourly? daily? weekly? monthly? Is it sudden or gradual? What were you doing when you first experienced it?  When do you usually experience it: daytime? night? early morning? Are you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs and symptoms? Does it ever occur before, during or after meals? Does it occur seasonally?

Documentation

In addition to the initial pain assessment, Curley emphasized the important of documenting:

• Patient’s understanding of the pain scale. Describe the patient’s ability to assess pain level using the 0-10 pain scale.
• Patient satisfaction with pain level with current treatment modality. Ask the patient what his or her pain level was prior to taking pain medication and after taking pain medication. If the patient’s pain level is not acceptable, what interventions were taken?
• Timely re-assessment following any intervention and response to treatment. Quote the patient’s response. 
• Communication with physician. Always report any change in condition.
• Patient education provided and patient’s response to learning.Don’t write “patient understands” without a supportive evaluation such as patient can verbalize, demonstrate, describe, etc.

(Reference: https://www.crozerkeystone.org/healthcare-professionals/nursing/crozer-keystone-nurses-in-the-news/eNewsletters/2010/february-march/best-practices-pqrst-method/)

The different scales used can be seen in Khoo Teck Phuat Hospital across used comprehensive chart which can be downloaded here



Another good pain related articles can be retrieved here:

• Nursing times (ads supported)