Kan man införa förbättrade smärtrutiner på vårdavdelningarna i ett helt landsting?

Background
The Pain- and Rehabilitation Centre at the University Hospital in Linköping, Sweden, provide education for nurses with special interest in pain management: pain representatives. A lack of systematic pain rating and documentation has been noted. The aim of this project was to implement uniform and systematic pain rating and documentation at the hospitals of the County Council of Östergötland, using the Numeric Rating Scale (NRS).

Methods
By educational lectures on standardized pain assessment using the NRS, systematic pain rating and documentation were implemented in care staff. Encouragement from the pain representative and continuous information were undertaken to support the compliance. In one survey in patients (IP) were asked if a standardized pain instrument hade been used and in another survey staff reviewed pain documentation in medical records (MR). Surveys were conducted prior to the implementation and followed up 6 months (6-FUP) and 12 months (12-FUP) after the implementation.

Results
Pain was assessed with NRS in 32.6 % (of 285 pain IP) at base line, in 45,9 % (of 157pain IP) 6-FUP: p-value 0,004, and in 50.6 % (of 81 pain IP): 12-FUP: p-value=0.006.
Pain assessment with NRS was documented in 7.2 % (of 405 MR) at base-line, in 34.5 % (of 229 MR) 6-FUP: p-value