drug-seeking behavior
Concerns about drug-seeking behavior also appeared to
lead to staff downgrading of patient-reported pain because
high scores would require prescription of opioids.
[Chatting with nurse in minor care unit who had
expressed concern about a patient asking for codeine] “I
asked why the previous patient hadn’t been given codeine
and she said, ‘You can’t give codeine for a 3 of 10, which
is why I coded him as a 3.’” (Observation, case study 1,
visit 1)
The fifth theme was the value of pain scores. The pain
score appeared to be useful for raising awareness,
prompting action, and understanding changes in patients’
pain. During observations, there was evidence that the
patient-reported pain score was being used as a relative
measure to communicate improvements in pain after
treatment. Staff also thought that the inclusion of
mandated pain score at initial assessment acted as a
reminder and was considered helpful in raising awareness of
patients’ pain.
S3S8: “It’s good that they do pain score on here [pointing
to the computer] because it forces you to consider it.”
(Informal conversation, case study 3, senior nurse)
Documentation of pain scores was also reported as
“difficult to ignore” in terms of prompting action, and
documentation of high levels of pain was observed to make
staff question why patients had not received analgesia. Staff
addressed concerns of “inaccurate” pain scores by using
qualifying information to provide justification
