Documentation. There was little documenta- tion of the effectiveness of the pain medications administered:
No documentation re: effectiveness of IV bolus of mor- phine or other pain relieving interventions. (Case 1, Nurse 2) For one child, half the dose of morphine was administered on three occasions, but nothing was recorded as to why this had taken place (Case 7). Unit policy dictated that nurses document a pain assessment on a flowchart within 2 hr of coming on duty. This chart had space for information about the location of pain, the child’s pain score, characteris- tics of the pain, nonpharmacological strategies, and pharmacological interventions. However, informa- tion in the flowchart was of variable quality. Pain medications were usually listed, but details on pain scores and non pharmacological methods used were not always provided. Nurses were also expected to complete a handover form to share patient information between shifts.This form had a section relating to pain care. Most docu- mentation related to the last time pain medications had been given. Sometimes the handover form or flowchart detailed the non pharmacological methods being used and occasionally a painscore was recorded:
Paperwork completed at 1940 hours indicates that the non-drug methods to be used were ice packs and dis- traction. (Case 1, Observation 2)