583: Quality improvement research in pain assessments in a a specialist rehabilitation setting.

Topic: Education, Societal Impact, and Others
Subtopic: Education

Background and Aims: Pain is the most common complaint among the general population to healthcare workers globally. Pain assessments are routinely carried out in the National Rehabilitation Hospital (NRH) daily by staff during routine evaluations and when the patient highlights their suffering as worsening or otherwise intolerable.
The Trakcare electronic healthcare record (EHR) includes a simple built-in pain assessment which is routinely used in clinical practice to assess pain for further clinical evaluation and accurate record keeping by all team members. Early work by the authors revealed substantial deficits in this tool and the implementation within the clinical environment of the NRH, as well as persistent reliance on facets of the dualistic model of pain (1).
This prompted the development of a new proforma and a series of educational events to promote biopsychosocial approaches to pain assessment and management by staff, along with a new proforma for pain assessment. This prompted retrospective review.

Methods: This study was performed with the approval of the Research Ethics Committee as a sub-study of the “Painful Truths at 18 months study”. Data was initially screened for staff and patient identifying features and these were removed.
Data entries were rated for that specific field as clinically appropriate ‘3’, of poor quality ‘2’, irrelevant ‘1’ or entirely absent ‘0’. Pain descriptions were deemed appropriate if they included both words describing the painful experience and details of the means used to assess the pain or for the new proforma, if more than two descriptors were used. Eight data fields were assessed creating a total rating between 0-24 for each pain assessment entry. A score between 0-9 was considered inadequate for clinical practice, 10-14 as poor, and entries >14 were adequate for clinical use. Optimal entries were considered as those with a total score >20 for both the old proformas and new.

Results: Between January-July 2024 2114 assessments were documented compared to a total of 3129 assessments between August 2025 – March 2026. The vast majority of EHR pain assessments were, as expected, completed by staff nurses (99%). Overall, a clear improvement in pain assessment quality was appreciated with use of the new proforma over the old. However, the quality of assessments with the old proforma did not show overall improvements, suggesting more benefits from the tool than educational efforts. The proportion of incomplete old proformas was substantially decreased over time from 31.2% to 14.2%. One of the main findings, was no obvious diurnal variation and no perceptible improvements in pain assessments with the old proforma between 2024 and the follow-up. No difference was seen between days of the week either.

Conclusions: The study failed to demonstrate substantial improvements in holistic pain assessment in all domains targeted. However, an increased proportion of filled assessments, and greater adoption of the new proforma with overall improved quality of assessments suggests more attention to detail and clarity has resulted. While the data does not prove direct clinical benefits for patients, this may be topic of a follow-up study integrating analgesic pharmacotherapy, non-pharmacological therapies and psychosocial context.
This study highlights the need for bespoke tools to be integrated with careful forethought and dedicated training for all staff. Educational efforts are of limited benefit in changing institutional practices, but better developed tools have a much greater impact.

References: 1) Francis & Morgan - Irish Medical Journal - July/August 2026

Presenting Author: Dr Matthew Francis
Submitting Author: Matthew Francis

Senior Author: Dr Matthew Francis

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Jacinta Morgan: MB, MSc, FRCPI, FRCP, PG Dip in HPE - National Rehabilitation Hospital