The application of clinical audit to improve pain control following third molar surgery

A telephone survey was used to assess adequacy of pain control after third molar removal in a series of three audits. After each audit, factors contributing to failure to control pain adequately and poor patient compliance with our analgesic regimen were identified. Changes in practice were then introduced to remedy areas of weakness and improve outcome. Despite an apparently sound protocol for the prescription of analgesics for patients having third molar surgery, the first audit revealed that 53% of patients experienced moderate to severe pain. After the introduction of written patient instructions to clarify the use of post-operative analgesics, the second audit demonstrated that 86% had their pain managed successfully. After subsequently increasing the post-operative Ibuprofen doses from 400 mg to 600 mg, the third audit showed that 96% of patients had satisfactory pain control. The use of clinical audit with an evidence-based analgesic regimen and clear, written patient instruction has improved post-operative pain control.

This paper demonstrates the usefulness of clinical audit for the monitoring and improvement of pain control and analgesic prescribing regimens following oral surgery, which in turn may improve patient experience and outcome.