A Pain Rating Scale For All Patients
It incorporates facial expressions, ranked numbers and familiar words.

We wanted to standardize our post-op pain assessments because staff were using different pain scales and patients were often too groggy to quantify their pain. To get everyone on the same page, we placed an 8-inch-by-11-inch laminated card at each bedside that contains:

• the Wong-Baker FACES Pain Rating Scale,
• a word descriptor pain scale (from "slight pain" to "excruciating pain"), and
• the visual-analog pain scale (patients pick a number between 1 and 10 to describe the pain's severity).

Before the procedure, we tell patients how to use the scales and ask them what pain level they'd like to be at before going home. If the post-op patient finds that using the 1-to-10 scale is too difficult, all he has to do is refer to the card and point to the appropriate face or agree to a word description, and the nurse can tell by the result how that choice correlates to the other pain scales. This is especially valuable when we're dealing with children, cognitively impaired patients or anyone with a language barrier.

Thanks to these cards, we know our pain assessments are reliably consistent. Our patients understand what they're being asked and can give us clear answers about how they feel.

Kelli Sheeran, RN
Grand Valley Surgical Center
Grand Rapids, Mich.
[email protected]

Use A Memo Book to Keep Your Staff Updated
Communicating important announcements to staff is always a challenge. Using a bulletin board becomes ineffective as it begins to amass papers that crinkle and yellow over time. Word-of-mouth is spotty. During a staff meeting, one of our nurses suggested that we begin using a "Memo Book" to keep staff in the loop. Everyone loved the idea. We filled a plain binder with loose-leaf paper and began storing meeting minutes in it. We placed it in a central location that was accessible to everyone. As the staff checked the book regularly, we added such additional information as procedural changes and TQM reports. We write each entry on a separate page for easy readability. Vacationing and part-time staff can easily page through the information they missed while they were out. While it's not required, some initial each page to confirm that they read it.

Carole Shirk, RN, BS
Berks Urologic Surgery Center
Wyomissing, Pa.
[email protected]

Stagger Staff Arrival Times
Staggering my staff's arrival times benefited my small hospital in many ways. One, we reduced overtime considerably. Two, we had coverage for the one surgeon working here who'd usually do cases from 7 a.m. to 8 p.m. or 9 p.m., alternating between an OR and an endoscopy room. And three, I wouldn't get aggravated seeing staff sitting in the lounge drinking coffee because they had nothing to do. Here's what we did. The first team came in at 6:45 a.m. for a two-hour case. The second team came in one to two hours later for the start of the second case. An on-call team came in three hours later. All staff got their full eight hours in, but there was very little overtime pay.

Judith A. Diss, RN (retired)
Salem Township Hospital
Salem, Ill.
[email protected]