[Evaluation of pain management at a university hospital center]

A hospital-wide evaluation of the process and results of pain management was set up at the Bordeaux University Hospital, France, as part of a pain management quality improvement program. The methods and the main results of a cross-sectional survey are reported.

All hospitalized patients, all nurses, and all head physicians the day of the survey were interviewed in a "given day" cross-sectional study. Six validated self-assessment or behavioral rating scales of pain were administered by three trained interviewers. Six process and result indicators were elaborated by a multiple-professional working group to allow simple and rapid feedback to the wards.

A total of 2254 patients (87% of the population), age range 1 day to 101 years, and 203 physicians and 314 nurses in 140 wards participated in the survey. Two processes were satisfactorily performed: delivery of information on pain control at the arrival of the patient and rapidity of medication administration. On the contrary, two out of three painful patients were not detected by both nurses and physicians; one out of three patients were given no treatment in medical wards and one out of five in surgical wards. These proportions were greater for patients unable to self-assess their pain. Nearly 40% did not understand the information on their pain medication. One out of two patients felt that their pain was unrelieved by the treatment. The prevalence of pain was nearly 50% except in geriatric wards (21%) and in pediatric patients aged 5 to 15 years (26%). Patient satisfaction was good for 75% of the adult patients.

A complete evaluation kit was developed for this first hospital-wide study in France on pain management. The individual and global results, sent to each ward, were designed to help all healthcare workers to become more aware of the urgent need to improve pain management and to serve as a basis for future evaluations.