PA1 An internal audit into the adequacy of pain assessment in a hospice setting

Pain is the most common presenting symptom of patients referred to palliative services. The effective management of pain is therefore paramount to any palliative service. The SOCRATES mnemonic is a pain assessment framework that is widely used by healthcare professionals to help them to remember to ask about key questions concerning a patient's pain. The eight elements of this framework are Site, Onset, Character, Radiation, Associated Factors, Timing, Exacerbating and Relieving Factors and Severity.

To assess whether 100% of patients admitted to the hospice in a three month period with pain as a symptom were fully assessed using all elements of the SOCRATES mnemonic. Furthermore to ensure whether these patients were written up for regular and breakthrough analgesia medication.

New admissions from February to April were identified using SystmOne™ and their records searched for mention of pain as a symptom and a score assigned according to the number of elements of SOCRATES used. The medications section on SystmOne™ was checked for the prescription of analgesia.

The results revealed that 0% of patients were fully assessed using all elements of the SOCRATES mnemonic and 66.7% of patients were partially assessed. The mean average of SOCRATES elements used when assessing pain was 3.3. Regular and breakthrough analgesia were prescribed for 100% of patients who complained of pain.

This hospice meets standards for prescribing analgesia, however significantly falls below standards on the assessment of pain using all elements of the SOCRATES mnemonic.