Both pain and constipation are frequent in patients with cancer and can remain inadequately treated and controlled, but including nurse assessment of pain and constipation into the provider note template improved documentation and treatment of both at an urban cancer center. These results were published in a report in the Journal of Oncology Practice.

Since treatment of cancer pain relies heavily on the use of opioid analgesics, bowel dysfunction, especially constipation, is a common adverse event and must be incorporated into the development of a successful pain management plan.

Researchers at a large, public health care system in Atlanta, Georgia, identified documentation of pain and constipation to be below benchmark levels and initiated a quality improvement program. Their goal was to improve documentation of pain and constipation by at least 20% within 1 year.

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The initial pain score documentation was 66.7%. Upon implementation of the nursing assessment onto the provider note template, pain score documentation increased to 100% (P <.01). Additionally, implementation of a pain management plan improved from 65.3% to 86.4% (P =.06).

The increase in documentation of constipation assessment was even more dramatic, from an initial score of 20.4% to 100% (P <.01). The rate of constipation management plans nearly tripled, increasing from 11.2% to 29.1% (P <.01).

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Based on this intervention, by the third clinic visit, pain control improved from an initial rate of 61.5% to 86.8% (P <.01).

“[T[he standardization and automation of pain and constipation assessment and documentation exceeded the goal of the improvement initiative. These revealed improved pain management outcomes in our clinic,” concluded the authors.


Chineke I, Adams Curry M, Bell W, et al. Improving documentation of pain and constipation management within the cancer center of a large urban academic hospital [published online September 7, 2019]. J Oncol Pract. doi: 10.1200/JOP.19.00332