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Pain as
the 5th Vital Sign: Impact on Pain Management at the Portland Veterans
Affairs Medical Center
Principal Investigator: Richard Mularski, MD
Co-Investigators: Lois Miller, PhD, RN and Linda Ganzini, MD
Pain is one of
the most common reasons people seek medical care and one of the most
difficult symptoms for practitioners to evaluate, making accurate pain
measurement crucial to proper care. The purpose of this study was to
measure improvement in pain measurement and management using the 1999
Veterans Health Administration directive of documenting patients' self
report of pain in the vital sign section of medical records. This VA
policy established pain as the 5th vital sign for the purpose of prompting
practitioners to assess pain comprehensively and initiate intervention
strategies if a self-reported pain score warrants such measures, thus
improving pain evaluation and management. Compliance with the directive
is 95%, but to date there have been no studies that examine the efficacy
of the strategy. This project determined the usefulness of the pain
as the 5th vital sign strategy for proper pain management and the effect
this strategy has on practitioner behavior in terms of assessment, evaluation,
and treatment of pain. Medical records were reviewed to obtain data
about pain assessment and treatment at clinic visits in the Portland
Veterans Affairs Medical Center. The study compared pain assessment
and management before and after implementation of the policy to provide
an indication whether regarding pain as the 5th vital sign has promoted
change in practice behavior and improvements in patient outcomes.
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