Quality statement 2: Regular assessment of pain relief

Quality statement

People with an acute painful sickle cell episode have an assessment of pain relief every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours.

Rationale

Assessment of pain relief is important for determining the effectiveness of the analgesia given at the time of presentation. It is also important for ensuring that more painkillers are given when needed until the episode has ended or the patient is discharged. Using an age-appropriate pain scoring tool ensures consistency when assessing pain and helps healthcare professionals to ensure that pain relief is appropriate.

Quality measures

Structure

Evidence of local arrangements to ensure that people with an acute painful sickle cell episode have their pain relief reassessed every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours.

Data source: Local data collection.

Process

a) Proportion of people with an acute painful sickle cell episode who have their pain relief reassessed every 30 minutes after pain relief is started until satisfactory pain relief has been achieved.

Numerator – the number of people in the denominator who have their pain relief reassessed every 30 minutes after pain relief is started until satisfactory pain relief has been achieved.

Denominator – the number of people with an acute painful sickle cell episode.

Data source: Local data collection.

b) Proportion of people with an acute painful sickle cell episode who have achieved satisfactory pain relief who have their pain relief assessed at least every 4 hours until discharge or the end of the episode.

Numerator – the number of people in the denominator who have their pain relief assessed at least every 4 hours until discharge or the end of the episode.

Denominator – the number of people with an acute painful sickle cell episode who have achieved satisfactory pain relief.

Data source: Local data collection.

c) Proportion of people with an acute painful sickle cell episode who have their pain relief reassessed using an age-appropriate pain scoring tool.

Numerator – the number of people in the denominator who have their pain relief reassessed using an age-appropriate pain scoring tool.

Denominator – the number of people with an acute painful sickle cell episode.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that they have sufficient resources to reassess pain relief in people with an acute painful sickle cell episode every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours until discharge or the end of the episode.

Healthcare professionals ensure that they reassess pain relief in people with an acute painful sickle cell episode every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours until discharge or the end of the episode.

Commissioners ensure that they commission services that have sufficient resources to reassess pain relief in people with an acute painful sickle cell episode every 30 minutes until satisfactory pain relief has been achieved, and then at least every 4 hours until discharge or the end of the episode.

What the quality statement means for patients, service users and carers

People with a painful attack of sickle cell disease (acute painful sickle cell episode) have their pain relief checked every 30 minutes until they are comfortable and then at least every 4 hours until they leave hospital or their episode has ended.

Source guidance

  • Sickle cell acute painful episode (NICE clinical guideline 143), recommendation 1.1.12.

Definitions of terms used in this quality statement

Assessment of pain relief

Assessment of pain relief should be done using an age-appropriate pain scoring tool and by asking questions such as:

  • How well did that last painkiller work?

  • Do you feel that you need more pain relief?

[NICE clinical guideline 143, recommendation 1.1.12]

Satisfactory pain relief

Satisfactory pain relief depends on the individual patient and is reached when the patient confirms that they are satisfied with their level of pain relief. [adapted from NICE clinical guideline 143]

Timing of assessments

Assessment of pain relief should be done every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours when pain relief is satisfactory, until either discharge or the end of the acute painful sickle cell episode. [adapted from NICE clinical guideline 143]

Equality and diversity considerations

Most people with sickle cell disease are of African or African-Caribbean origin. This may mean that language needs to be taken into account when deciding on the type of pain scoring tool to be used. Age, especially if the person is a young child, and any physical, sensory or learning disabilities also need to be taken into account.