Measuring the "fifth vital sign" in cataract surgery patients--is it necessary?

As an ophthalmic nurse, you may wonder why it is so important to assess and manage the pain, or "fifth vital sign" of cataract surgery patients. How much pain could a patient experience as a result of a relatively short procedure? In January 2004, while reviewing the pain levels of 135 outpatient surgery patients undergoing cataract surgery, 21% of the patients reported pain. Twelve percent (12%) experienced mild pain and 9% experienced moderate to severe pain. Pain relief was recorded in 38% of cases. It was noted that there was no pain reassessment recorded by nurses in 62% of cases, demonstrating a deficit in pain assessment and documentation. At our institution, the Wilmer Eye Institute at Johns Hopkins Hospital, there is a pain assessment and management policy that requires a postoperative pain goal be identified prior to any surgical procedure. Hospital guidelines should be followed for documentation of pain in the outpatient setting. To improve the quality of pain assessment and documentation, and to meet the hospital compliance rate of 85%, an audit was performed on 60 outpatient cataract surgery charts over a one-month period. An initial compliance rate of 83% was established. After staff education and changes to the critical pathway, a re-audit demonstrated an increase to 95% in pain assessment and documentation.