Pain Management in Acute Surgical Inflammatory Intra-Abdominal Conditions

Abstract

Aim: To assess compliance of pain assessment and management in patients with cholecystitis, pancreatitis and diverticulitis with respect to WHO Analgesic Ladder and NICE Guidance. Method(s): After receiving approval from the Clinical Effectiveness Team, patients (n=50) presenting with the above conditions not undergoing surgical intervention at index admission, over a two-month period were included. Patients were identified using the ICD 10 coding system. The first cycle was a retrospective review of patients' notes. The audit results were discussed with the supervisor thereafter. The surgical senior house officers underwent a teaching session. Then a second, prospective cycle (n=30) was conducted to assess change thereby closing the audit loop. Result(s): In the first cycle, documentation of (1) pain intensity in initial presentation was initially measured at 36% and (2) pain progression during hospital stay was at 70%. The prescription of (a) appropriate analgesia on initial presentation was at 44% and (b) hyoscine in cases of cholecystitis was at 55%. The avoidance of NSAIDS and regular opioids in cases of diverticulitis was at 85%. In the second cycle, significant improvement was noted with documentation of pain intensity at 76.6% and pain progression at 86.6%, Additionally, prescription of appropriate analgesia was at 73.3% and hyoscine in cholecystitis cases at 81.8% with avoidance of NSAIDS and opioids in diverticulitis cases at 100%. Conclusion(s): The teaching session improved both the prescription of the correct analgesics and documentation of monitoring the progression and intensity of pain. Furthermore, this has ultimately resulted in a relative decrease in length of hospital stay.