SMOOTHING SEAMS FOR SAFETY

the extent of their implementation. The American Geriatrics Society guidelines on the management of persistent pain in older people have specific recommendations on this topic. Wider adoption of either one, or a relatively small portfolio of pain assessment tools, would arguably lead to a common language of pain assessment among doctors and nurses, facilitate training and awareness, and support audit and research. Use of such scales by consultant geriatricians in the Republic of Ireland was audited. A Medline search was conducted to catalogue pain scales in use in the English-speaking literature, the settings in which these pain scores were being employed, and whether the scales had been validated. This process revealed seven commonly used scales that were then used to develop a questionnaire distributed to all 58 consultant geriatricians in the Republic of Ireland. Thirty-eight replies were received, a response rate of 66%. Twenty-two consultants (58%) used no pain assessment tool routinely. The NRS was used most frequently (24%; 9 consultants), followed by the VAS (18%; 7) and VRS (18%; 7). Four consultants (10.5%) each used the Faces Pain Scale (FPS) and McGill pain questionnaire. One consultant (3%) each used the Brief Pain Inventory and Checklist of Non-Verbal Indicators. For patients with mild cognitive impairment, 25 consultants (66%) did not use any pain assessment tool routinely. Six (16%) most commonly used the VAS, followed by the VRS and NRS (5 each, 13%). For those with moderate to severe cognitive impairment 28 consultants (76%) were not using a pain scale routinely. Four consultants (10.5%) most commonly used the FPS. Thirty consultants (79%) recorded results of pain assessment in the clinical notes. Nine (26%) reported that it was recorded in the nursing notes, and four (10.5%) recorded pain assessment in the observation charts. Five consultants (13%) kept no fixed record. Twenty-three consultants (61%) recorded symptoms of pain, with decrease in physical activity (23, 61%) and appetite (23, 61%) most commonly recorded. Forty-two percent, 39%, and 5% recorded relationship with others, emotions, and concentration, respectively, and 3% recorded mood. Twenty-two consultants (58%) considered making pain the fifth vital sign to be of value. Six consultants (16%) did not think it would be useful. Three consultants (8%) had no fixed opinion on this. These results suggest that significant scope exists for agreement on, and adoption of, pain scales for older people in geriatric medicine services in Ireland. The high level of support for incorporating pain as the fifth vital sign suggests that this might also be useful for improving detection and measurement of pain in older people in hospital services. Arising from this research, a Delphi process is planned to try to develop a consensus on giving preference to a single assessment tool for the assessment of pain in service for older people in Ireland. Further work with geriatricians, gerontological nurses and clinicians in palliative care in Europe might usefully inform the selection of appropriate instruments and help to develop a common language for the detection, assessment, and recording of pain experienced by older adults, with a view to better management of pain and suffering.