APPENDIX 1
IRISH TEACHING HOSPITALS ACUTE PAIN SERVICES QUESTIONNAIRE
Q1Does your hospital have an accredited training program or is it affiliated to a university?
Yes
No
Q2 Does your hospital have ...
<100
100-200
>200
>400 beds
Q3 Does your hospital have a formal pain management program or service- that is, a program with written guidelines, policies and procedures?
Yes
No
Don’t Know/Not Applicable
Q4Below is a list of components that might be part of a pain management program. For each please tell me whether your hospital has this component.
Management of acute pain not related to surgery
Management of chronic pain
Management of cancer pain
Acute postoperative pain management
Q5What services are provided through the program?
Consultation
Direct patient management
PCA management
Continuous nerve block techniques
Intrathecal opiates
None of these
Q6What year did your hospital start its formal acute pain management program?
Q7Does your hospital plan to establish a formal acute pain management program or service that will include the management of post surgical pain?
Yes
No
DK/NA
If No go to qxn 11
Q8In what year does your hospital plan to establish a formal pain management program that will include the management of post surgical pain?
2004
2005
2006
DK/NA
Q9For the following possible goals, please tell me whether each is, or will be, a primary goal of your hospitals pain management program
Minimizing or controlling post surgical pain
Minimizing or controlling acute pain not related to surgery
Reducing patient adverse effects from surgery
Reducing patient hospital stay
Q10For each of the following items, please tell me whether it is or will be a component of your acute pain management program?
- Written guidelines
- Written goals and objectives for post surgical pain management
- List of procedures requiring post surgical pain management
- Standards to follow when prescribing post surgical pain management
- A list of available pain management medications and non drug treatments with guidelines for their use
- A pain assessment sheet or other pain measurement tool to assess a patients level of pain
- Continuing medical education for professionals
- Quality assurance measures
- On-call personnel
Q11Which of the following positions best describes the individual who is or should be in charge of the acute pain management team?
An anaesthetist
Pain physician
Some other physician
Pharmacist
Nurse
Administrator
Someone else
DK/NA
Q12Which of the following professionals are members of the acute pain management team?
Surgeon
Anaesthetist
Pharmacist
Nurses
Social workers
Patient representatives
Q13How many full time equivalents of anaesthetists would you estimate would be devoted to pain management?
Q14How many full time equivalents of pharmacists would you estimate would be devoted to pain management?
Q15How many full time equivalents of nurses would you estimate would be devoted to pain management?
Q16Summary of full time equivalents
Q17For acute pain does your hospital offer…
PCA
Epidural analgesia including infusions
Continuous LA infusions
Other nerve blocks
TENS
Q18Do patients receive counseling on acute pain management?
Yes
No
DK/NA
Q19Which of the following professionals are involved in the counseling of patients about acute pain management..
Surgeons
Anaesthetists
Nurses
Pharmacists
Social workers
Patient representatives
Q20When is a patient counseled? Is it
Before Hospitalization
Day of Sx
Eve of Sx
Post op
Days post op some other time
Dk/NA
Q21 Which of the following tools do you use for pain management
Verbal numerical rating scale
VAS
Adjective rating scale
Sedation scores
Q22How familiar are you with the clinical practice guidelines for acute pain management issued by AAGBI or ASA task force on acute pain management? Would you say you are,,
Very familiar
Somewhat familiar
Only a little familiar
Have only heard of
Have never heard of
Q23Does your hospital have a copy of these guidelines?
Q24Have these guidelines influenced your pain management program?
Have influenced
Expect them to influence
Will not influence at all
DK/NA
Q25Is control of patient’s pain part of your hospital’s quality assurance program?
Yes
No
DK/NA
Q26Do you believe the trend in pain management consultation is…
Increasing
Staying the same
Decreasing
DK/NA
Q27 Where is your hospital?
North
Northeast
Northwest
West
Southwest
South
Southeast
Dublin
Midlands