A focus on the recording of post-neutering pain scores
- zeropainphilosophy
- 6 days ago
- 6 min read
Zero Pain Practice - Broadleys Veterinary Hospital, Stirling, Scotland
Authors - Kristi Cherry RVN & team
What would you like to improve?
Broadleys Veterinary Hospital is a multi-disciplinary hospital based in Stirling, Scotland. The hospital runs a first-opinion and referral service that specialises in orthopaedics, neurology, cardiology, ophthalmology, and oncology. The practice currently holds hospital status and has a strong quality improvement (QI) drive to ensure best standard of care.
We recently made changes to our hospital sheets to include a box to record the patient’s pain score. It has been noted that on occasion pain score were not being filled out. This was found to be more common in routine first-opinion cases that would be going home the same day as the surgery was performed.
The recognition of pain is an important element of nursing care and should be closely monitored. Pain in animals has been directly linked to detrimental physiological consequences including; poor wound healing, poor appetite, fluctuations in blood pressure, cytokine production, and poor immunity (Bloor & Alan, 2017).
The aim of this audit is to determine whether pain assessment in routine neutering is being documented, and whether changes could be implemented to improve this. The Glasgow Composite pain score was used to score patients four to six hours after their premedication for consistency.
What will your target for improvement be?
Documentation of the first pain score is 80% of cases.
Data Collection
● The first cycle of the audit was aimed at gauging the baseline number of pain scores being carried out in every patient undergoing routine neutering four to six hours post premedication being administered. Additionally, the following were recorded;
- All medication administered to the patient peri-operatively
- If rescue analgesia was given
- Operation carried out (ovariohysterectomy, castration)
Standardised protocol;
- Premedication with methadone + a sedative.
- Induction with propofol and maintenance with 100% oxygen and sevoflurane to effect, as prescribed by a veterinary surgeon.
Baseline findings
The first audit cycle was completed in January 2025 to provide a baseline non-bias result pool to determine whether interventions were required to make improvements upon. All circulating wards staff were informed of the results of this audit, allowing for any feedback to be addressed and an improvement plan to be formulated.
Pain scoring was added to the hospital sheet as a completion box. Staff were reminded to highlight this box four to six hours after the patient had been pre-medicated to ensure that pain scoring was not missed. Pain scoring charts had been laminated for ease of use in the wards facility, which could be hung on the patients kennel to remind staff to fill it in and simplify data collection. Additional training was provided to staff using the Glasgow Composite pain scoring system to ensure staff familiarity and maximise the recording of accurate results.
As a result of this audit, a re-audit was then carried out to determine whether these changes had an influence on the amount of patients being pain scored after their procedure and being provided with rescue analgesia if required.
In the first stage of the audit, 15 neutering operations were analysed over one month (January 2025).
The results showed;
· 53.3% (8/15) had a recorded pain score on their hospitalisation chart
· 60% (9/15) had a pain score requested on their hospitalisation chart
· 2 patients were unable to be pain scored accurately due to their behaviour
· The average pain score was 1.3 (n=8)
· 13.3% (1/15) of dogs were over the pain threshold (pain score >5/20)
· 13.3% of neuters required rescue analgesia.
The following interventions were put in place to ensure pain assessments were being carried out and recorded.
1. Staff to highlight a box four-six hours after premedication was given to make it obvious to wards staff when pain score is due to be completed.
2. Reminders to pain score patients were placed on the nurse notice board.
3. Glasgow Pain Score sheets readily available and laminated, this could be filled in and placed on the patients kennel making it obvious for staff walking by that the patient’s pain has been assessed.
4. A meeting was held to make staff aware of the results of this audit, pinpointing where improvements could be made.
5. Additional training given to staff regarding pain assessment.
6. A plan was made to re-audit the results after the interventions had been put in place for two months to assess how these interventions were working.
The re-audit took place in April 2025, which allowed time to implement changes. 14 routine neutering operations were analysed over this one month period.
The results showed;
· 85.7% (12/14) had a recorded pain score on their hospitalisation chart
· 1 patient was unable to be pain scored accurately due to their behaviour
· The average pain score was 2.9 (n=12).
· 7.1% (1/14) of dogs were over the pain threshold (pain score >5)
· 7.1% of neuters required rescue analgesia.
Impact of the intervention
A post-operative pain management protocol was designed to create a standardised approach to analgesia.
Adding a pain score box to the hospital sheet meant there was a lot less paperwork involved and made it easily visible to the rest of the team whether or not a pain score had been carried out. Displaying the pain score prominently on the patient sheet enabled the team to quickly identify patterns and trends, leading to more timely and informed decision-making. This was particularly useful during shift changes, where information can be lost due to the high volume of inpatients.
Additionally having multiple laminated copies of the Glasgow Composite Pain scoring reference sheet readily available in wards meant that they could be hung on patient’s kennels as another reminder to make sure that it was completed for each patient.
Sharing the outcome of the first audit made sure that the full team were made aware of the data and allowed staff to share their own ideas on what improvements could be made to increase the frequency of pain scoring. Pain score chart completion rated increased by 32.4% over the two-month period, with a 100% rate of providing rescue analgesia when pain was score higher than 5.
Was the target met? Yes
Did the change made in Cycle 1 affect this?
Yes – the team were very engaged with the audit as a result of our findings.
Barriers encountered
· One of the barriers of this audit was convincing staff that pain scoring patients was not going to cause a large increase in workload.
· Some members of staff stated that they would recognise a patient was painful and go directly to the veterinary surgeon in charge to get additional rescue analgesia rather than filling in the pain score and making notes on the patients hospital sheet
· Not all staff were in attendance for the meeting regarding the outcome of the first audit. Although the minutes were printed out and placed on the notice board, some staff may not have read these.
· Some patient’s behaviour meant that pain scores could not be carried out without risking harm to staff, these patients are often discharged earlier and with additional oral analgesia to ensure that they are comfortable at home. Owners are also sent home with a client-friendly pain scoring sheet which they are taught how to utilise on discharge so that they can contact the practice if they believe their pet is uncomfortable.
· Some patients were discharged before the four hours had elapsed to carry out a pain score. In future staff may have to take this into consideration before booking an animal’s discharge time to make sure the patient has access to additional analgesia if warranted.
As a direct result of this audit, the author observed that staff had developed a habit of neglecting to record pain scores consistently, which may hinder effective pain management and the ability to track patient progress over time. After all veterinary staff were made aware of the audit results, there was a marked increase in the frequency of pain scores being recorded on patients hospital records, with re-audit results clearly showing a significant improvement. This audit also identified that patients that pain scored higher than 5 always received rescue analgesia which provided reassurance that staff could identify when to intervene.
For the next re-audit it may be useful to gather more data to check whether staff are continuing to adhere to this protocol as time passes. Additionally, further data collection could be carried out to check whether pain scoring is consistent across all departments.
Could you conduct this same audit?
Do you have the tools and support you need?
We recommend the resources on the RCVS Knowledge website for clinical audit support.
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