Development of core pain management indicators for hospitalized patients: a Delphi study

Development of core pain management indicators for hospitalized patients: a Delphi study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of core pain management indicators for hospitalized patients: a Delphi study Yang Zhou, Biyun Zeng, Fangmin Peng, Yabin Guo, Xiaotong Liu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4569545/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Pain is one of the most common symptoms of hospitalized patients. Currently, the hospital-wide incidence of pain ranges from 37.7% to 84%, and the severity of pain during hospitalization is closely related to the prognosis and the quality of hospital care. Effective and accurate monitoring of pain occurrence and intervention is an indispensable step to improve overall performance and patient satisfaction. Currently, the pain management system in the nursing field has not been integrated with the information system, and there are too many indicators, different grading standards, and clinical generalization is not strong. The existing indicators lack specificity and sensitivity, lack of pain management for hospitalized patients related indicators, prone to the problem of imbalance in pain care management. Objective : To construct high-sensitivity, concise, scientific, and easy-to-implement pain management core indicators for hospitalized patients, providing a reference basis for standardizing pain management during hospitalization. Methods: First, based on the literature review and hospital evaluation criteria, the core indexes of pain management were collected, screened, and determined, and the framework of the index system was established to form the draft of the core indexes of pain management. Then, core indicators of inpatient pain management were determined by Delphi expert correspondence. Results: Two rounds of expert consultation were issued 16 questionnaires, all recovered, with a questionnaire response rate of 100%. The results show that the experts are highly motivated. In addition, the average authority coefficient (CR) of 16 experts was 0.972, indicating consistency between expert opinions used and determined. The concordance of the two rounds of expert correspondence was 0.170~0.279 ( p < 0.05), and the range of the coefficient of variation (CV) was 0~0.3, which indicated that the concordance among the members of the expert group was excellent and the results were reliable. After 2 rounds of Delphi expert letters, the final determination of 6 in-patient pain management core indicators, included pain screening rate within 8hours of admission, incidence of Pain, Incidence of moderate to severe pain, intervention rate for moderate to severe pain, reassessment rate of moderate to severe pain, and patient satisfaction with pain management. Conclusion: This study Delphi method to identify six key indicators of pain management in hospitalized patients. The indicators were specific, scientific, concise, and useful for clinical practice, the indexes were extracted and monitored automatically, which provided the basis for improving the quality of pain nursing. Delphi method Pain care Nursing quality Nursing sensitive indicator Information system Figures Figure 1 Figure 2 1 Introduction Pain is one of the most common symptoms of hospitalized patients. The incidence of hospital-wide pain ranged from 37.7–84%, and the incidence of severe pain ranged from 9–36%[ 1 ]; in China, the incidence of patient pain during hospitalization is 63.08%[ 2 ], the incidence of moderate to severe pain during hospitalization is as high as 48.7%[ 3 ]. During hospitalization, patients face multifaceted pain caused by invasive procedures such as disease, surgery, and diagnosis, and their severity is closely related to their recovery and satisfaction with pain management [ 3 ]. Persistent moderate to severe pain can affect patient prognosis, prolong hospital stay, increase hospitalization costs, and reduce patient satisfaction [ 3 , 4 ]. Therefore, achieving precise and scientific pain management in a timely and effective manner to alleviate patient pain is a challenge faced by healthcare professionals [ 5 , 6 ]. In February 2023, the Chinese government released the “National Third Level Public Hospital Performance Evaluation Operation Manual (2023 Edition)”, which regards pain management as an important indicator target for assessing inpatient satisfaction and measuring the service quality of medical institutions [ 7 ]. Therefore, effective monitoring of the occurrence and intervention of patient pain during hospitalization can provide relevant references for decision-makers, researchers, and healthcare professionals, thereby improving overall hospital performance and providing high-quality medical services to patients. In recent years, with the rapid development of pain medicine and the transformation of pain management mode, nurses play a more and more important role in pain assessment and treatment, and the evaluation of nursing quality has gradually changed from descriptive and empirical extensive evaluation to data and scientific fine evaluation [ 8 ]. Nursing quality sensitive indicators are quantitative measurement tools for nursing quality, used to evaluate clinical nursing activities and quality [ 9 ], and also important means of nursing quality management. A review of relevant literature found that scholars from all over the world have mainly used different methods to construct evaluation systems to evaluate the quality of hospital nursing and pain nursing management. For example, Chen Jiajia et al. constructed the quality index system of postoperative pain management in China through the Delphi method, including a total of 43 evaluation indicators from three aspects of structure, process, and result, to evaluate the quality of postoperative pain management [ 10 ]. However, there are many complicated indicators and it is not easy to promote in clinical practice. Susan L. Beck et al. from the United States explored patient-centered inpatient pain quality and outcome indicators through three-level mixed effects modeling and other methods and pointed out that quality supervision measures should be dynamic, and hospitals need to use quality indicators to achieve continuous improvement of pain care quality [ 6 ]. Chinese scholar Huang Tianwen et al. established 5 pain nursing quality evaluation indicators based on the research method of nursing quality evaluation indicators, aiming at the management of pain nursing quality in orthopedic wards. However, its use was limited to orthopedic wards, and it was not combined with the information medical record system, and the efficiency in practical application needs to be improved [ 11 ]. To sum up, the pain management system currently constructed still has problems such as too many indicators, different rating standards, and poor clinical promotion[ 12 ], which lacks specificity and sensitivity. Moreover, relevant studies have shown that nurses still do not pay enough attention to pain and do not master enough pain knowledge in the pain management of hospitalized patients, resulting in delayed analgesic treatment and low satisfaction with analgesia, especially the lack of relevant monitoring for patients with moderate and severe pain[ 13 , 14 ]. Meanwhile, with the rapid development of global medical informatization, combining informatization can effectively improve the quality control process of specialized nursing and promote the comprehensive improvement of specialized nursing quality[ 15 ]. Therefore, based on evidence-based pain guidelines, and relevant evaluation standards, and combined with the actual situation of specific hospitals, rational use of the developed quality control information system, formulate scientific, reliable, and intelligent core indicators of pain management for hospitalized patients, and focus on strengthening the monitoring of moderate and severe pain. Compared with the evaluation system, core indicators have the advantages of more flexible use and higher feasibility. It can also timely find the loopholes in the process of pain nursing management, and achieve continuous quality improvement for moderate and severe pain. This study preliminarily constructs the core indicators of pain management for hospitalized patients based on evaluation criteria and literature reports and monitors the core indicators of pain management based on the previously constructed pain information management system to improve the quality of pain management. 2 Measures 2.1 Study design This study aims to construct the core indicators of pain management for inpatients through the Delphi method and to achieve continuous improvement of pain nursing quality according to index monitoring. The Delphi method is a structured process using the inquiry form compiled by the investigators (supplementary document 1) to seek relevant opinions from experts and obtain expert advice. After repeated inquiries and feedback, the group reached a reliable consensus according to the statistical analysis results and expert feedback. This not only reflects the personal knowledge and experience of each expert but also collects the wisdom and opinions of different experts to the maximum extent [ 16 ]. 2.2 Construction of original indicators 2.2.1 Preliminary preparation work To further standardize pain nursing management and improve the pain experience of patients, the pain nursing management team of our hospital was established in 2012, and the hospital pain management system was formed. Pain screening and assessment were required for hospitalized patients within 8 hours after admission. Nurses selected assessment tools according to the age and specific conditions of patients, from the Numerical Rating Scale (NRS), Verbal Descriptor Scale (VDS), and Faces Pain Scale-Revised (FPS-R). The NRS was composed of 11 numbers with the same interval from 0 to 10: no pain (0), mild pain (1–3), moderate pain (4–6), and severe pain (7–10). VDS used "no pain, mild pain, moderate pain, severe pain, severe pain, and the most pain" to represent different levels of pain intensity. To better statistical data, our hospital unified standards, the six pain levels were assigned as 0-2-4-6-8-10; patients were asked to rate the overall pain level from 0 (no pain) to 10 (worst pain), and the FPS-R provided cartoon pictures of six facial expressions (ranging from smile and sadness to painful crying) to represent the pain level represented by the scoring area. Based on the above assessment methods, a score of 1 or more indicates that the patient experienced pain, a score of 1 to 3 indicates mild pain and a score of 4 or more indicates that the patient was in moderate to severe pain. The process of assessment and reassessment of moderate and severe pain is shown in Fig. 1 [ 17 ]. 2.2.2 Construction of Indicators Following the needs of this study, the researchers set up a pain index construction research team. The team’s main responsibilities were to develop themes, initially identify monitoring indicators, prepare an expert letter questionnaire, and select experts for the correspondence. To ensure quality, an internal group meeting was held to assess the appropriateness of the questionnaire before its distribution to experts; the team is responsible for sending, collecting, and sorting out correspondence information, and statistical analysis of the results. Based on the Nursing Quality sensitive index “pain assessment-intervention-reassessment” recommended by the National Database of Nursing-sensitive Quality Indicators (NDNQI) [ 18 ], according to the “National Tertiary Public Hospital Performance Appraisal Operation Manual (2023 version)” issued by the Chinese government[ 19 ], and combined with the actual situation of the hospital, the research team initially constructed the core indicators of pain management for inpatients from the perspective of “assessment-intervention-reassessment”. The preliminary indicators included the following five: the screening rate of pain within 8 hours after admission, the incidence of pain, the incidence of moderate and severe pain, the reassessment rate of moderate and severe pain, and the satisfaction rate of pain management. 2.3 The Delphi process 2.3.1 Components of Letter Questionnaire The questionnaire included three parts: (1) Research background and objectives. (2) Expert consultation form for “Development of monitoring indicators for moderate and severe pain in hospitalized patients”. Experts were asked to evaluate the importance, rationality, and feasibility of each indicator in each round, and put forward corresponding revisions. Importance, plausibility, and feasibility were all rated on a Likert scale ranging from 1 to 5; 5 points for very important (reasonable/feasible), 4 points for relatively important (reasonable/feasible), 3 points for moderately important (reasonable/feasible), 2 points for not very important (reasonable/feasible), and 1 point for very unimportant (reasonable/feasible). Expert’s judgment criteria (Ca) and familiarity with each indicator (Cs) were subsequently scored. The evaluation criteria are based on four aspects: theoretical analysis, practical experience, domestic and foreign references, and intuitive feelings (see Table 1 for specific assignment). The degree of familiarity of experts with the index was divided into: very familiar (1.00), very familiar (0.80), generally familiar (0.60), not familiar (0.40), and not familiar (0.20). (3) Basic information of experts: including the working years, education background, professional title, judgment basis familiarity with the indicators, etc. See supplementary document 1 for details of the questionnaire Table 1 The judgment criteria of experts Judgment basis Degree of contribution to expert judgment Large Medium Small Practical experience 0.5 0.4 0.3 Theoretical analysis 0.3 0.2 0.1 Reference literature at home and abroad 0.1 0.1 0.05 Intuitive feeling 0.1 0.1 0.05 2.3.2 Experts selection and survey This study used the judgmental sampling method. The selection criteria for inquiry experts are as follows: the requirement for academic qualifications and professional titles is a bachelor's degree or above; those with a senior technical title and a clinical frontline expert title at an intermediate level or above; pay attention to pain management and be familiar with the research progress and current situation in this field; voluntarily and actively participate in this study. 2.3.3 Expert Consultation Based on the principles of voluntary, confidential, and informed consent, the research team conducted two rounds of Delphi surveys from March to April 2023 by the guidelines for conducting and reporting Delphi research. A total of 16 experts received letter inquiries. Questionnaires were sent and received by email, and respondents were asked to complete the questionnaire within two weeks to avoid expert memory bias. According to the first round of expert opinions, the research team modified, supplemented, and deleted the indicators to form the second round of expert consultation table. Experts who did not complete one round of consultation were no longer invited to participate in the second round of consultation. Meanwhile, if the expert chose to be less familiar or not familiar with the content of the questionnaire in the first round of consultation, the next round of consultation for the expert was also canceled. After two rounds of Delphi letter consultation, the experts' opinions showed a good central tendency and reached a consensus. 2.4 Data analysis The data were input into Excel and imported into SPSS27.0 software for analysis. The general situation of experts and the recovery of consultation questionnaires were described by frequency and percentage. The enthusiasm of the experts was expressed in the rate of questionnaire recovery in each round and the rate of experts who made recommendations. The degree of harmony ( Kendall’s coefficient of concordance W ) was tested by chi-square test. The authority coefficient was expressed by calculating the arithmetic mean of the judgment basis and familiarity of the experts. P < 0.05 was considered statistically significant. 3 Results 3.1 Positive coefficient of experts In two rounds of consultation, 16 questionnaires were sent out and 16 were recovered, with a recovery rate of 100%. The number of experts who put forward suggestions in the first and second rounds were 9 and 3, accounting for 56.25% and 18.75%, respectively, and a total of 23 written suggestions were put forward. The positive coefficient of experts refers to the degree of cooperation and emphasis of research experts. The recovery rate of commonly used expert consultation questionnaires indicates that the higher the positive coefficient is, the more important the experts attach to the research. It is generally believed that a recovery rate of over 70% is considered a good motivation. In this study, the positive coefficient of expert consultation was 100%, indicating that experts attach great importance to this study and have high enthusiasm. 3.2 Degree of Expert Authority The degree of expert authority is used to quantify and calculate the strength of expert authority, which has a significant impact on the reliability of the study. The authority coefficient (Cr) was calculated by using the basis of expert judgment (Ca) and the degree of expert familiarity (Cs) : (Cr= (Ca + Cs) /2). It is generally considered that Cr ≥ 0.80 indicates a high degree of authority. In this study, 16 letters were sent out and 16 letters were recovered in both rounds. The average authority coefficient Cr of 16 experts was 0.972, which indicated that the authority of the consulting experts in this study was high, and the analysis of the experts for this study was based on practical experience and theoretical analysis, which indicated that the research results were highly credible. 3.3 Coefficient of coordination of expert opinions Consistency between expert opinions was determined using the coefficient of variation (CV) and the Kendall concordance coefficient (W value). The concordance W value for the two rounds of inquiry ranged from 0.170 ~ 0.279 (p < 0.05), with a CV range of 0 ~ 0.3, indicating excellent concordance among panel members, as detailed in Table 2 . Table 2 Kendall coordination coefficient Items W value χ 2 df P-value CV Round 1 (n = 16) Importance 0.279 17.827 4 0.001 0.07 ~ 0.28 Plausibility 0.170 10.893 4 0.028 0.20 ~ 0.30 Feasibility 0.214 13.669 4 0.008 0.11 ~ 0.22 Round 2 (n = 16) Importance 0.227 18.182 5 0.003 0 ~ 0.30 Plausibility 0.208 16.612 5 0.005 0.08 ~ 0.29 Feasibility 0.206 16.506 5 0.006 0.10 ~ 0.29 3.4 Modification and determination of indicators After two rounds of the Delphi survey, we summarized the suggestions of the expert group, added the index of “intervention rate of moderate and severe pain in patients”, and finally determined 6 core indicators of pain management in hospitalized patients. The specific process of this study is shown in Fig. 2 . The monitoring content, calculation formula, and collection method of the indicators are shown in Table 3 . Table 3 Core indicators, content, formulas, and data collection methods for pain management in hospitalized patients Core indicators Content and significance Calculation formula Data collection Pain screening rate within 8 hours of admission Whether the pain assessment and record of newly admitted patients were comprehensive and standardized. \(\frac{\begin{array}{c}Number of discharged patients\\ who underwent pain assessment \\ within 8 hours of admission\\ within a specific period of time\end{array}}{\begin{array}{c}Total number of discharged patients \\ during that period\end{array}}\times 100\%\) Pain assessment information (times of assessments) and the number of discharged patients were collected through the Haitai medical record system, and the number of patients who completed the assessment within 8 hours after admission, the number of patients discharged during a specific period who experienced pain or moderate to severe pain during hospitalization was obtained. Incidence of pain To understand the current situation of pain in hospitalized patients, and take preventive measures according to the changes of indicators timely. \(\frac{\begin{array}{c}Number of patients discharged \\ during a specific period of time \\ who experienced pain \\ during hospitalization\end{array}}{\begin{array}{c}Total number of discharged patients \\ during that period\end{array}}\times 100\%\) Incidence of moderate to severe pain To understand the current situation of moderate to severe pain in hospitalized patients, to promote the concept of preventive analgesia and multimodal analgesia. \(\frac{\begin{array}{c}Number of patients discharged \\ during a specific period of time \\ who have experienced moderate to \\ severe pain during hospitalization\end{array}}{\begin{array}{c}Total number of discharged patients \\ during that period\end{array}}\times 100\%\) Intervention rate for moderate to severe pain To examine the implementation of intervention measures for patients with moderate and severe pain. \(\frac{\begin{array}{c}Number of patients with pain intensity \ge 4 points \\ during a specific time period recorded \\ in the medical record system with pain interventions\end{array}}{\begin{array}{c}Number of patients with pain intensity \ge 4 points \\ evaluated during a specific time period\end{array}}\times 100\%\) Reassessment rate of moderate to severe pain The effect of the analgesic intervention and the reaction of patients were checked, and the nurse's review and record were comprehensive. \(\frac{\begin{array}{c}Total number of reassessments\\ conducted after pain intensity \ge 4 points \\ within a specific time period\end{array}}{\begin{array}{c}Total times of assessments \\ of pain intensity \ge 4 points \\ within a specific time period\end{array}}\) ×100% Patient satisfaction with pain management Whether the patients were satisfied with the pain management work, to obtain suggestions for targeted improvement. \(\frac{\begin{array}{c}Number of satisfied cases \\ +\\ number of very satisfied cases\end{array}}{Total number of surveyed cases }\) ×100% Patients filled in the pain management satisfaction item score, and 0 ~ 5 points indicated very dissatisfied, dissatisfied, general, satisfied, and very satisfied 3.5 The Application of Core Pain Management Indicators Based on the previously designated pain management system, the nursing department of the hospital cooperated with the information center to automatically extract the frequency of moderate and severe pain and other specific data during hospitalization through the reporting method of our hospital's Haitai electronic medical record system, with technical support provided by the information center. Nursing staff input the results after assessment and intervention. Nursing managers only need to select the data required for each index in the pain information management system, and the system can complete the automatic calculation and obtain the index results. The pain information management system implemented hierarchical authority for the logged-in personnel. Based on the information system, the head nurse, the department head nurse, and the nursing department could extract data from different departments and areas, realize data distribution, ward data entry, generate ward data, hospital data summary, statistics, and chart generation, and realize data reporting and feedback to each ward. 4 Discussion After two rounds of expert consultation, six core indexes were formed: pain screening rate within 8hours of admission, incidence of Pain, Incidence of moderate to severe pain, intervention rate for moderate to severe pain, reassessment rate of moderate to severe pain, and patient satisfaction with pain management With the rapid development of pain medicine and the increasing attention of the public to pain, improving the quality of pain management has become one of the key work contents of medical institutions. How to evaluate the quality of pain nursing management in a targeted and scientific way has become a hot topic for researchers. The change in the pain management model requires nurses to play more and more important roles in pain assessment and treatment. The results showed that nurses did not pay enough attention to pain and did not record standards in pain management of in-patients, which led to delayed analgesia and low satisfaction of patients, and the current study lacked relevant monitoring of patients with moderate and severe pain, ignoring the impact of moderate and severe pain on patients [ 13 , 14 ]. Patients with moderate or severe pain have the characteristics of obvious pain, intolerable pain, disturbed sleep, and need for drug analgesia, pain without timely intervention can significantly affect patients' activities, sleep, mood, and patients satisfaction with treatment [ 20 ]. Therefore, the core indicators of pain management in this study not only cover routine indicators of pain management but also focus on monitoring the evaluation and intervention of moderate to severe pain. Not only can it improve the coverage of the first pain assessment for patients upon admission, but it can also provide targeted dynamic evaluations of the occurrence, intervention, and reassessment of moderate to severe pain, thereby increasing the level of attention given by nurses to moderate to severe pain. Patient satisfaction is defined as the patient's self-assessment, fully considering the patient's feelings, improving the authenticity of the survey results, and effectively promoting the quality of pain care. On the one hand, the six core indexes in this study are in line with the trend that nursing quality evaluation changes from the empirical extensive evaluation to the scientific and precise evaluation, on the other hand, it can make up for problems such as too many indexes, different grading standards and weak clinical generalization, and embody the specificity and sensitivity of the core indexes of pain management. The pain evaluation management indicators were quantified and digitized, which made the pain nursing quality evaluation more accurate and efficient, and the data processing more objective. In nursing quality management, the realization of quantitative evaluation of nursing quality plays an important guiding role in the scientific evaluation of nursing quality and continuous improvement of nursing management level[ 21 ]. In the past, the quality of orthopedic pain care is usually based on experience management, the lack of quantitative standards, and accuracy is not ideal[ 22 ]. Nursing quality evaluation has gradually transitioned from the evaluation system to the use of specific core indicators, and the use of nursing-sensitive indicators to manage and control nursing quality is the development trend of nursing quality evaluation under the new situation. Relying on the hospital’s Haitai electronic medical record system and based on the pain information management system that has been developed, this study developed six core indicators of pain management. Each indicator was described in detail and fully integrated into the daily pain nursing work. Nurses can not only comprehensively pay attention to the pain of patients from admission to discharge and during hospitalization, but also quantify pain assessment and intervention of patients. At the same time, with the help of the hospital's pain quality management information system, the data needed by the nurses' pain comprehensive assessment scale and the patient's follow-up form in the electronic medical record information system were automatically extracted, information-based data collection indicators needed to make nursing quality evaluation more accurate, efficient, more objective data processing, in line with the application trend of artificial intelligence in nursing management[ 23 ]. Nurses can feedback on the occurrence of moderate and severe pain and the intervention effect to the medical group in time, provide first-hand clinical data for doctors, and evaluate the treatment effect of moderate and severe pain in time. Dynamic and normalized monitoring of pain management indicators based on information systems is implemented to improve the quality of pain management throughout the hospital. With the technical support provided by the information center, the data collected from the electronic medical record system are processed by the system logic operation, and the index results, charts, dynamic analysis, and clinical tracing are automatically generated. The University of California, Los Angeles extracted information from the Epic electronic health system database into a perioperative data warehouse to achieve extended management of patient data[ 24 ]. The approach of this study is similar to that of others. Nursing managers can view the dynamic changes of six core indicators through the pain management information system of our hospital, and realize the dynamic monitoring of pain assessment, intervention, reassessment, and patient satisfaction. The changing trend of the core indicators can reflect the overall quality of pain nursing in each department, ward, and the whole hospital more scientifically and comprehensively, find the weak links, and guide the adjustment and improvement. Under the condition of regular monitoring of pain, the pain management information system was used to realize the automation and normalization of data extraction through the core indicators of pain management, to improve the quality of pain management in the whole hospital. The core indicators of this study provide a tool for pain management in hospitalized patients. However, the monitoring index has not been practiced in other hospitals. In the future, multi-center research and practice should be carried out to continuously evaluate the monitoring effect and improve it The data collection of the index needs the support of a reliable information system. In China, the digital infrastructure of hospitals is different, and there may be some obstacles in the promotion. In the future, efforts should be made towards the establishment of a unified pain monitoring and management index in the country to improve the quality of clinical pain nursing management, and to enhance the consciousness of pain assessment, intervention, and reassessment of nursing staff, to alleviate patients pain, to improve patients satisfaction with pain management. 5 Conclusion In this study, six core pain indicators were obtained by the Delphi method, making pain care more standardized and having practical application value. Compared with the evaluation system, the evaluation index is more concise, more convenient to use in clinical practice, more implementable, standardized, and targeted, which can promote the quality of pain care. Declarations Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by the Ethics Committee of Xiangya Hospital of Central South University. Informed consent was obtained from all subjects. Consent for publication Not applicable. Competing interests None. Contributions Yang Zhou conceived and designed the study, performed the analyses, interpreted the data, drafted the first draft, and approved the final manuscript as submitted; Yang Zhou* was involved in data collection and monitoring of the entire study design and facilitated the entire process; Bi-Yun Zeng and Fang-Min Peng were responsible for interfacing with the clinic and providing relevant assistance; and Yabin Guo and Xiaotong Liu were responsible for revising and improving the manuscript. All authors agreed to publish this manuscript. Funding statement This study was supported by the Department of Education of Hunan Province, and the science foundation number was 2023JGB043. Acknowledgments We would like to thank all authors for their investment in research design. Thank you also to the medical workers and relevant staff from the hospital information department who participated in the research. They have spent time and energy completing a meaningful job. References Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J CLIN NURS. 2016;25(5–6):583–98. Li L, Xuping X, Jiping L, Hong Z, Yun B, Jin L. Nursing management in the implementation of the first-time in-patient pain survey in China. Chin J Pain Med. 2015;21(8):630–2. Liu Y, Xiao S, Yang H, Lv X, Hou A, Ma Y, Jiang Y, Duan C, Mi W, Yang J, et al. Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. Lancet Reg health Western Pac. 2023;39:100822. Xiuli W, Miao HE, Yan Z, Xi W, Haiyan Z. Strategies and effectiveness on improving quality of nursing care for inpatients with moderate to severe pain. Chin Nurs Manage. 2023;23(10):1467–71. Meissner W, Huygen F, Neugebauer E, Osterbrink J, Benhamou D, Betteridge N, Coluzzi F, De Andres J, Fawcett W, Fletcher D, et al. Management of acute pain in the postoperative setting: the importance of quality indicators. CURR MED RES OPIN. 2018;34(1):187–96. Beck SL, Dunton N, Berry PH, Brant JM, Guo JW, Potter C, Spornitz B, Eaton J, Wong B. Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes. MED CARE. 2019;57(2):159–66. Miao HE, Xiuli W, Haiou QI, Yang Z, Li LI, Chunxia R, Wenbin J, Jianmei W, Liyuan XU, Minjun L, et al. Survey of pain nursing management status in 145 hospitals of China. Chin Nurs Manage. 2023;23(10):1441–6. Lei-wen T, Zhi-hong YE, Hong-ying P. Construction of a nursing sensitive quality indicators system. Chin J Nurs. 2013;48(9):801–3. Heslop L, Lu S. Nursing-sensitive indicators: a concept analysis. J ADV NURS. 2014;70(11):2469–82. Chen J, Tong Y, Cheng Y, Xue Z, Liu M. Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management. PAIN MED. 2020;21(12):3270–82. Tian-wen H, Xiao-ling C, Yun-juan T, Li P, Qiao-li L, Cui-huan H. Li-fen C, Shou-zheng C: Effect of pain management quality indicators on improving quality of pain management in the orthopedic department. Chin J Nurs. 2015;50(02):148–51. Wei W, Fengjuan L, Zhenxiang L, Dong K, Wenhong Z. Construction and clinical application of nursing quality and safety monitoring indexes. J Nurs Sci. 2015;30(3):44–7. Mędrzycka-Dąbrowska W, Dąbrowski S, Gutysz-Wojnicka A, Basiński A, Kwiecień-Jaguś K. Nurses' Knowledge and Barriers Regarding Pain Management. J PERIANESTH NURS. 2018;33(5):715–26. Gao L, Mu H, Lin Y, Wen Q, Gao P. Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa. J PAIN RES. 2023;16:1767–78. Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA. Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews. J MED INTERNET RES. 2017;19(4):e122. Chen L, Huang LH, Xing MY, Feng ZX, Shao LW, Zhang MY, Shao RY. Using the Delphi method to develop nursing-sensitive quality indicators for theNICU. J CLIN NURS. 2017;26(3–4):502–13. Postoperativepain assessment and. nursingin adults-CHINESE NURSING ASSOCIATION(CNA).|.*2024* 2024 .; 2024. Jinrui C, Ying C. Research progress in nursing-sensitive quality indicators. J Nurs Sci. 2014;29(12):88–91. Notice of the General Office of the National Health Commission on Issuing the Performance Assessment Operation Manual for National Third level Public Hospitals. (2023 Edition) _ State Council Departmental Document _ China Government Website.|.*2024* 2024 .; 2024. Deng LX, Patel K, Miaskowski C, Maravilla I, Schear S, Garrigues S, Thompson N, Auerbach AD, Ritchie CS. Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults. J AM GERIATR SOC. 2018;66(9):1744–51. Jiayue C, Yongxing W, Xiaolan Z, Mei G, Bin S. Application of the data processing method for the quantitative variable in nursing quality evaluation. J NURS ADMIN. 2004;4(8):24–6. Xiurong Y, Wenqin Y. The Current Situation and Reflection on the Clinical Nursing Quality Evaluation System. Chin J Nurs 2005(09):697–9. Shi J, Wei S, Gao Y, Mei F, Tian J, Zhao Y, Li Z. Global output on artificial intelligence in the field of nursing: A bibliometric analysis and science mapping. J NURS Scholarsh. 2023;55(4):853–63. Epstein RH, Hofer IS, Salari V, Gabel E. Successful Implementation of a Perioperative Data Warehouse Using Another Hospital’s Published Specification From Epic’s Electronic Health Record System. Anesth Analgesia. 2021;132(2):465–74. Additional Declarations No competing interests reported. Supplementary Files supplementarydocument1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4569545","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":325180004,"identity":"894604a9-5c69-4cf0-b061-5e7072b0699e","order_by":0,"name":"Yang Zhou","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Zhou","suffix":""},{"id":325180005,"identity":"539636ca-1a0e-4a43-bd9b-240da7246867","order_by":1,"name":"Biyun Zeng","email":"","orcid":"","institution":"Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Biyun","middleName":"","lastName":"Zeng","suffix":""},{"id":325180006,"identity":"a6208594-8387-491c-bf7f-2f7ec0e701cc","order_by":2,"name":"Fangmin Peng","email":"","orcid":"","institution":"Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Fangmin","middleName":"","lastName":"Peng","suffix":""},{"id":325180007,"identity":"b66ba561-9296-4bae-814c-6becd867ed1f","order_by":3,"name":"Yabin Guo","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Yabin","middleName":"","lastName":"Guo","suffix":""},{"id":325180010,"identity":"6fd14e57-7835-4fa3-a4e4-0002f3bcd650","order_by":4,"name":"Xiaotong Liu","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Xiaotong","middleName":"","lastName":"Liu","suffix":""},{"id":325180011,"identity":"11421ec4-c0a8-484f-91c9-974d852c742d","order_by":5,"name":"Yang zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYDACCSjNxsx+4MAHCNuAOC187D2JD2eQpEWO54CxMQ8xWuRnNx+T5qm5Y9cmkZAmbVNTl9jA3rxNgqHmDk4tjHOOpUnzHHuW3CaReEw659jhxAaeY2USDMee4dTCLJFjJs3DdjiZDWRLbsOBxAagiARjw2GcWtjAWv6BtZhJWzYAHSb/Br8WHpAW3rbDdmwg7zM2MANt4cGvRUIiLdlybt/hBDZQIPccO2zcxpNWbJFwDLcW+RnJB2+8+XbYXr4ZGJU/aupk+9kPb7zxoQa3FhBgAkZHYgPcdyAiAa8GYED/YGCwJ6BmFIyCUTAKRjIAANUrUJ1ZSKxNAAAAAElFTkSuQmCC","orcid":"","institution":"Xiangya Hospital of Central South University","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"zhou","suffix":""}],"badges":[],"createdAt":"2024-06-12 10:36:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4569545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4569545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60600680,"identity":"8385e7f1-82ad-46a0-9ba6-43a7ff88fa74","added_by":"auto","created_at":"2024-07-18 16:02:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":123022,"visible":true,"origin":"","legend":"\u003cp\u003eThe flow diagram of pain assessment.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4569545/v1/c9913f9367c573d37b8ef14d.jpeg"},{"id":60600679,"identity":"247d7df3-3941-4268-a459-4fb6f2ca7c6f","added_by":"auto","created_at":"2024-07-18 16:02:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30388,"visible":true,"origin":"","legend":"\u003cp\u003eThe flow diagram of the study.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4569545/v1/e806d3a9942d2c0a9db21f50.png"},{"id":64583089,"identity":"75a841a1-e194-45f7-b787-16b29870f340","added_by":"auto","created_at":"2024-09-16 07:00:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":784663,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4569545/v1/b212cc93-3e4f-4a8c-b223-14c3a7db8f1e.pdf"},{"id":60600681,"identity":"53912e46-627e-430e-8967-2afcb879b2b4","added_by":"auto","created_at":"2024-07-18 16:02:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":36894,"visible":true,"origin":"","legend":"","description":"","filename":"supplementarydocument1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4569545/v1/eda8e39056f59a697f8728a0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of core pain management indicators for hospitalized patients: a Delphi study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003ePain is one of the most common symptoms of hospitalized patients. The incidence of hospital-wide pain ranged from 37.7\u0026ndash;84%, and the incidence of severe pain ranged from 9\u0026ndash;36%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]; in China, the incidence of patient pain during hospitalization is 63.08%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the incidence of moderate to severe pain during hospitalization is as high as 48.7%[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. During hospitalization, patients face multifaceted pain caused by invasive procedures such as disease, surgery, and diagnosis, and their severity is closely related to their recovery and satisfaction with pain management [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Persistent moderate to severe pain can affect patient prognosis, prolong hospital stay, increase hospitalization costs, and reduce patient satisfaction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, achieving precise and scientific pain management in a timely and effective manner to alleviate patient pain is a challenge faced by healthcare professionals [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In February 2023, the Chinese government released the \u0026ldquo;National Third Level Public Hospital Performance Evaluation Operation Manual (2023 Edition)\u0026rdquo;, which regards pain management as an important indicator target for assessing inpatient satisfaction and measuring the service quality of medical institutions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, effective monitoring of the occurrence and intervention of patient pain during hospitalization can provide relevant references for decision-makers, researchers, and healthcare professionals, thereby improving overall hospital performance and providing high-quality medical services to patients.\u003c/p\u003e \u003cp\u003eIn recent years, with the rapid development of pain medicine and the transformation of pain management mode, nurses play a more and more important role in pain assessment and treatment, and the evaluation of nursing quality has gradually changed from descriptive and empirical extensive evaluation to data and scientific fine evaluation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nursing quality sensitive indicators are quantitative measurement tools for nursing quality, used to evaluate clinical nursing activities and quality [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and also important means of nursing quality management. A review of relevant literature found that scholars from all over the world have mainly used different methods to construct evaluation systems to evaluate the quality of hospital nursing and pain nursing management. For example, Chen Jiajia et al. constructed the quality index system of postoperative pain management in China through the Delphi method, including a total of 43 evaluation indicators from three aspects of structure, process, and result, to evaluate the quality of postoperative pain management [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, there are many complicated indicators and it is not easy to promote in clinical practice. Susan L. Beck et al. from the United States explored patient-centered inpatient pain quality and outcome indicators through three-level mixed effects modeling and other methods and pointed out that quality supervision measures should be dynamic, and hospitals need to use quality indicators to achieve continuous improvement of pain care quality [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Chinese scholar Huang Tianwen et al. established 5 pain nursing quality evaluation indicators based on the research method of nursing quality evaluation indicators, aiming at the management of pain nursing quality in orthopedic wards. However, its use was limited to orthopedic wards, and it was not combined with the information medical record system, and the efficiency in practical application needs to be improved [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. To sum up, the pain management system currently constructed still has problems such as too many indicators, different rating standards, and poor clinical promotion[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which lacks specificity and sensitivity. Moreover, relevant studies have shown that nurses still do not pay enough attention to pain and do not master enough pain knowledge in the pain management of hospitalized patients, resulting in delayed analgesic treatment and low satisfaction with analgesia, especially the lack of relevant monitoring for patients with moderate and severe pain[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Meanwhile, with the rapid development of global medical informatization, combining informatization can effectively improve the quality control process of specialized nursing and promote the comprehensive improvement of specialized nursing quality[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Therefore, based on evidence-based pain guidelines, and relevant evaluation standards, and combined with the actual situation of specific hospitals, rational use of the developed quality control information system, formulate scientific, reliable, and intelligent core indicators of pain management for hospitalized patients, and focus on strengthening the monitoring of moderate and severe pain. Compared with the evaluation system, core indicators have the advantages of more flexible use and higher feasibility. It can also timely find the loopholes in the process of pain nursing management, and achieve continuous quality improvement for moderate and severe pain. This study preliminarily constructs the core indicators of pain management for hospitalized patients based on evaluation criteria and literature reports and monitors the core indicators of pain management based on the previously constructed pain information management system to improve the quality of pain management.\u003c/p\u003e"},{"header":"2 Measures","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis study aims to construct the core indicators of pain management for inpatients through the Delphi method and to achieve continuous improvement of pain nursing quality according to index monitoring. The Delphi method is a structured process using the inquiry form compiled by the investigators (supplementary document 1) to seek relevant opinions from experts and obtain expert advice. After repeated inquiries and feedback, the group reached a reliable consensus according to the statistical analysis results and expert feedback. This not only reflects the personal knowledge and experience of each expert but also collects the wisdom and opinions of different experts to the maximum extent [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Construction of original indicators\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Preliminary preparation work\u003c/h2\u003e \u003cp\u003eTo further standardize pain nursing management and improve the pain experience of patients, the pain nursing management team of our hospital was established in 2012, and the hospital pain management system was formed. Pain screening and assessment were required for hospitalized patients within 8 hours after admission. Nurses selected assessment tools according to the age and specific conditions of patients, from the Numerical Rating Scale (NRS), Verbal Descriptor Scale (VDS), and Faces Pain Scale-Revised (FPS-R). The NRS was composed of 11 numbers with the same interval from 0 to 10: no pain (0), mild pain (1\u0026ndash;3), moderate pain (4\u0026ndash;6), and severe pain (7\u0026ndash;10). VDS used \"no pain, mild pain, moderate pain, severe pain, severe pain, and the most pain\" to represent different levels of pain intensity. To better statistical data, our hospital unified standards, the six pain levels were assigned as 0-2-4-6-8-10; patients were asked to rate the overall pain level from 0 (no pain) to 10 (worst pain), and the FPS-R provided cartoon pictures of six facial expressions (ranging from smile and sadness to painful crying) to represent the pain level represented by the scoring area. Based on the above assessment methods, a score of 1 or more indicates that the patient experienced pain, a score of 1 to 3 indicates mild pain and a score of 4 or more indicates that the patient was in moderate to severe pain. The process of assessment and reassessment of moderate and severe pain is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Construction of Indicators\u003c/h2\u003e \u003cp\u003eFollowing the needs of this study, the researchers set up a pain index construction research team. The team\u0026rsquo;s main responsibilities were to develop themes, initially identify monitoring indicators, prepare an expert letter questionnaire, and select experts for the correspondence. To ensure quality, an internal group meeting was held to assess the appropriateness of the questionnaire before its distribution to experts; the team is responsible for sending, collecting, and sorting out correspondence information, and statistical analysis of the results. Based on the Nursing Quality sensitive index \u0026ldquo;pain assessment-intervention-reassessment\u0026rdquo; recommended by the National Database of Nursing-sensitive Quality Indicators (NDNQI) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], according to the \u0026ldquo;National Tertiary Public Hospital Performance Appraisal Operation Manual (2023 version)\u0026rdquo; issued by the Chinese government[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and combined with the actual situation of the hospital, the research team initially constructed the core indicators of pain management for inpatients from the perspective of \u0026ldquo;assessment-intervention-reassessment\u0026rdquo;. The preliminary indicators included the following five: the screening rate of pain within 8 hours after admission, the incidence of pain, the incidence of moderate and severe pain, the reassessment rate of moderate and severe pain, and the satisfaction rate of pain management.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 The Delphi process\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Components of Letter Questionnaire\u003c/h2\u003e \u003cp\u003eThe questionnaire included three parts: (1) Research background and objectives. (2) Expert consultation form for \u0026ldquo;Development of monitoring indicators for moderate and severe pain in hospitalized patients\u0026rdquo;. Experts were asked to evaluate the importance, rationality, and feasibility of each indicator in each round, and put forward corresponding revisions. Importance, plausibility, and feasibility were all rated on a Likert scale ranging from 1 to 5; 5 points for very important (reasonable/feasible), 4 points for relatively important (reasonable/feasible), 3 points for moderately important (reasonable/feasible), 2 points for not very important (reasonable/feasible), and 1 point for very unimportant (reasonable/feasible). Expert\u0026rsquo;s judgment criteria (Ca) and familiarity with each indicator (Cs) were subsequently scored. The evaluation criteria are based on four aspects: theoretical analysis, practical experience, domestic and foreign references, and intuitive feelings (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for specific assignment). The degree of familiarity of experts with the index was divided into: very familiar (1.00), very familiar (0.80), generally familiar (0.60), not familiar (0.40), and not familiar (0.20). (3) Basic information of experts: including the working years, education background, professional title, judgment basis familiarity with the indicators, etc. See supplementary document 1 for details of the questionnaire\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe judgment criteria of experts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eJudgment basis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eDegree of contribution to expert judgment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmall\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractical experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReference literature at home and abroad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntuitive feeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Experts selection and survey\u003c/h2\u003e \u003cp\u003eThis study used the judgmental sampling method. The selection criteria for inquiry experts are as follows: the requirement for academic qualifications and professional titles is a bachelor's degree or above; those with a senior technical title and a clinical frontline expert title at an intermediate level or above; pay attention to pain management and be familiar with the research progress and current situation in this field; voluntarily and actively participate in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Expert Consultation\u003c/h2\u003e \u003cp\u003e Based on the principles of voluntary, confidential, and informed consent, the research team conducted two rounds of Delphi surveys from March to April 2023 by the guidelines for conducting and reporting Delphi research. A total of 16 experts received letter inquiries. Questionnaires were sent and received by email, and respondents were asked to complete the questionnaire within two weeks to avoid expert memory bias. According to the first round of expert opinions, the research team modified, supplemented, and deleted the indicators to form the second round of expert consultation table. Experts who did not complete one round of consultation were no longer invited to participate in the second round of consultation. Meanwhile, if the expert chose to be less familiar or not familiar with the content of the questionnaire in the first round of consultation, the next round of consultation for the expert was also canceled. After two rounds of Delphi letter consultation, the experts' opinions showed a good central tendency and reached a consensus.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data analysis\u003c/h2\u003e \u003cp\u003eThe data were input into Excel and imported into SPSS27.0 software for analysis. The general situation of experts and the recovery of consultation questionnaires were described by frequency and percentage. The enthusiasm of the experts was expressed in the rate of questionnaire recovery in each round and the rate of experts who made recommendations. The degree of harmony ( \u003cem\u003eKendall\u0026rsquo;s coefficient of concordance W\u003c/em\u003e ) was tested by chi-square test. The authority coefficient was expressed by calculating the arithmetic mean of the judgment basis and familiarity of the experts. \u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Positive coefficient of experts\u003c/h2\u003e \u003cp\u003eIn two rounds of consultation, 16 questionnaires were sent out and 16 were recovered, with a recovery rate of 100%. The number of experts who put forward suggestions in the first and second rounds were 9 and 3, accounting for 56.25% and 18.75%, respectively, and a total of 23 written suggestions were put forward. The positive coefficient of experts refers to the degree of cooperation and emphasis of research experts. The recovery rate of commonly used expert consultation questionnaires indicates that the higher the positive coefficient is, the more important the experts attach to the research. It is generally believed that a recovery rate of over 70% is considered a good motivation. In this study, the positive coefficient of expert consultation was 100%, indicating that experts attach great importance to this study and have high enthusiasm.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Degree of Expert Authority\u003c/h2\u003e \u003cp\u003eThe degree of expert authority is used to quantify and calculate the strength of expert authority, which has a significant impact on the reliability of the study. The authority coefficient (Cr) was calculated by using the basis of expert judgment (Ca) and the degree of expert familiarity (Cs) : (Cr= (Ca\u0026thinsp;+\u0026thinsp;Cs) /2). It is generally considered that Cr\u0026thinsp;\u0026ge;\u0026thinsp;0.80 indicates a high degree of authority. In this study, 16 letters were sent out and 16 letters were recovered in both rounds. The average authority coefficient Cr of 16 experts was 0.972, which indicated that the authority of the consulting experts in this study was high, and the analysis of the experts for this study was based on practical experience and theoretical analysis, which indicated that the research results were highly credible.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Coefficient of coordination of expert opinions\u003c/h2\u003e \u003cp\u003eConsistency between expert opinions was determined using the coefficient of variation (CV) and the Kendall concordance coefficient (W value). The concordance W value for the two rounds of inquiry ranged from 0.170\u0026thinsp;~\u0026thinsp;0.279 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with a CV range of 0\u0026thinsp;~\u0026thinsp;0.3, indicating excellent concordance among panel members, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKendall coordination coefficient\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eW value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eRound 1\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;16)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eImportance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u0026thinsp;~\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePlausibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u0026thinsp;~\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFeasibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.11\u0026thinsp;~\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eRound 2 (n\u0026thinsp;=\u0026thinsp;16)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eImportance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u0026thinsp;~\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePlausibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08\u0026thinsp;~\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFeasibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.10\u0026thinsp;~\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Modification and determination of indicators\u003c/h2\u003e \u003cp\u003eAfter two rounds of the Delphi survey, we summarized the suggestions of the expert group, added the index of \u0026ldquo;intervention rate of moderate and severe pain in patients\u0026rdquo;, and finally determined 6 core indicators of pain management in hospitalized patients. The specific process of this study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The monitoring content, calculation formula, and collection method of the indicators are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCore indicators, content, formulas, and data collection methods for pain management in hospitalized patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCore indicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContent and significance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCalculation formula\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eData collection\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain screening rate within 8 hours of admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhether the pain assessment and record of newly admitted patients were comprehensive and standardized.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\begin{array}{c}Number of discharged patients\\\\ who underwent pain assessment \\\\ within 8 hours of admission\\\\ within a specific period of time\\end{array}}{\\begin{array}{c}Total number of discharged patients \\\\ during that period\\end{array}}\\times 100\\%\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePain assessment information (times of assessments) and the number of discharged patients were collected through the Haitai medical record system, and the number of patients who completed the assessment within 8 hours after admission, the number of patients discharged during a specific period who experienced pain or moderate to severe pain during hospitalization was obtained.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncidence of pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo understand the current situation of pain in hospitalized patients, and take preventive measures according to the changes of indicators timely.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\begin{array}{c}Number of patients discharged \\\\ during a specific period of time \\\\ who experienced pain \\\\ during hospitalization\\end{array}}{\\begin{array}{c}Total number of discharged patients \\\\ during that period\\end{array}}\\times 100\\%\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncidence of moderate to severe pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo understand the current situation of moderate to severe pain in hospitalized patients, to promote the concept of preventive analgesia and multimodal analgesia.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\begin{array}{c}Number of patients discharged \\\\ during a specific period of time \\\\ who have experienced moderate to \\\\ severe pain during hospitalization\\end{array}}{\\begin{array}{c}Total number of discharged patients \\\\ during that period\\end{array}}\\times 100\\%\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntervention rate for moderate to severe pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo examine the implementation of intervention measures for patients with moderate and severe pain.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\begin{array}{c}Number of patients with pain intensity \\ge 4 points \\\\ during a specific time period recorded \\\\ in the medical record system with pain interventions\\end{array}}{\\begin{array}{c}Number of patients with pain intensity \\ge 4 points \\\\ evaluated during a specific time period\\end{array}}\\times 100\\%\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReassessment rate of moderate to severe pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe effect of the analgesic intervention and the reaction of patients were checked, and the nurse's review and record were comprehensive.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\begin{array}{c}Total number of reassessments\\\\ conducted after pain intensity \\ge 4 points \\\\ within a specific time period\\end{array}}{\\begin{array}{c}Total times of assessments \\\\ of pain intensity \\ge 4 points \\\\ within a specific time period\\end{array}}\\)\u003c/span\u003e\u003c/span\u003e\u0026times;100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient satisfaction with pain management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhether the patients were satisfied with the pain management work, to obtain suggestions for targeted improvement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\begin{array}{c}Number of satisfied cases \\\\ +\\\\ number of very satisfied cases\\end{array}}{Total number of surveyed cases }\\)\u003c/span\u003e\u003c/span\u003e\u0026times;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients filled in the pain management satisfaction item score, and 0\u0026thinsp;~\u0026thinsp;5 points indicated very dissatisfied, dissatisfied, general, satisfied, and very satisfied\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.5 The Application of Core Pain Management Indicators\u003c/h2\u003e \u003cp\u003eBased on the previously designated pain management system, the nursing department of the hospital cooperated with the information center to automatically extract the frequency of moderate and severe pain and other specific data during hospitalization through the reporting method of our hospital's Haitai electronic medical record system, with technical support provided by the information center. Nursing staff input the results after assessment and intervention. Nursing managers only need to select the data required for each index in the pain information management system, and the system can complete the automatic calculation and obtain the index results. The pain information management system implemented hierarchical authority for the logged-in personnel. Based on the information system, the head nurse, the department head nurse, and the nursing department could extract data from different departments and areas, realize data distribution, ward data entry, generate ward data, hospital data summary, statistics, and chart generation, and realize data reporting and feedback to each ward.\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eAfter two rounds of expert consultation, six core indexes were formed: pain screening rate within 8hours of admission, incidence of Pain, Incidence of moderate to severe pain, intervention rate for moderate to severe pain, reassessment rate of moderate to severe pain, and patient satisfaction with pain management\u003c/p\u003e \u003cp\u003eWith the rapid development of pain medicine and the increasing attention of the public to pain, improving the quality of pain management has become one of the key work contents of medical institutions. How to evaluate the quality of pain nursing management in a targeted and scientific way has become a hot topic for researchers. The change in the pain management model requires nurses to play more and more important roles in pain assessment and treatment. The results showed that nurses did not pay enough attention to pain and did not record standards in pain management of in-patients, which led to delayed analgesia and low satisfaction of patients, and the current study lacked relevant monitoring of patients with moderate and severe pain, ignoring the impact of moderate and severe pain on patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Patients with moderate or severe pain have the characteristics of obvious pain, intolerable pain, disturbed sleep, and need for drug analgesia, pain without timely intervention can significantly affect patients' activities, sleep, mood, and patients satisfaction with treatment [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, the core indicators of pain management in this study not only cover routine indicators of pain management but also focus on monitoring the evaluation and intervention of moderate to severe pain. Not only can it improve the coverage of the first pain assessment for patients upon admission, but it can also provide targeted dynamic evaluations of the occurrence, intervention, and reassessment of moderate to severe pain, thereby increasing the level of attention given by nurses to moderate to severe pain. Patient satisfaction is defined as the patient's self-assessment, fully considering the patient's feelings, improving the authenticity of the survey results, and effectively promoting the quality of pain care. On the one hand, the six core indexes in this study are in line with the trend that nursing quality evaluation changes from the empirical extensive evaluation to the scientific and precise evaluation, on the other hand, it can make up for problems such as too many indexes, different grading standards and weak clinical generalization, and embody the specificity and sensitivity of the core indexes of pain management.\u003c/p\u003e \u003cp\u003eThe pain evaluation management indicators were quantified and digitized, which made the pain nursing quality evaluation more accurate and efficient, and the data processing more objective. In nursing quality management, the realization of quantitative evaluation of nursing quality plays an important guiding role in the scientific evaluation of nursing quality and continuous improvement of nursing management level[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In the past, the quality of orthopedic pain care is usually based on experience management, the lack of quantitative standards, and accuracy is not ideal[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Nursing quality evaluation has gradually transitioned from the evaluation system to the use of specific core indicators, and the use of nursing-sensitive indicators to manage and control nursing quality is the development trend of nursing quality evaluation under the new situation. Relying on the hospital\u0026rsquo;s Haitai electronic medical record system and based on the pain information management system that has been developed, this study developed six core indicators of pain management. Each indicator was described in detail and fully integrated into the daily pain nursing work. Nurses can not only comprehensively pay attention to the pain of patients from admission to discharge and during hospitalization, but also quantify pain assessment and intervention of patients. At the same time, with the help of the hospital's pain quality management information system, the data needed by the nurses' pain comprehensive assessment scale and the patient's follow-up form in the electronic medical record information system were automatically extracted, information-based data collection indicators needed to make nursing quality evaluation more accurate, efficient, more objective data processing, in line with the application trend of artificial intelligence in nursing management[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nurses can feedback on the occurrence of moderate and severe pain and the intervention effect to the medical group in time, provide first-hand clinical data for doctors, and evaluate the treatment effect of moderate and severe pain in time.\u003c/p\u003e \u003cp\u003eDynamic and normalized monitoring of pain management indicators based on information systems is implemented to improve the quality of pain management throughout the hospital. With the technical support provided by the information center, the data collected from the electronic medical record system are processed by the system logic operation, and the index results, charts, dynamic analysis, and clinical tracing are automatically generated. The University of California, Los Angeles extracted information from the Epic electronic health system database into a perioperative data warehouse to achieve extended management of patient data[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The approach of this study is similar to that of others. Nursing managers can view the dynamic changes of six core indicators through the pain management information system of our hospital, and realize the dynamic monitoring of pain assessment, intervention, reassessment, and patient satisfaction. The changing trend of the core indicators can reflect the overall quality of pain nursing in each department, ward, and the whole hospital more scientifically and comprehensively, find the weak links, and guide the adjustment and improvement. Under the condition of regular monitoring of pain, the pain management information system was used to realize the automation and normalization of data extraction through the core indicators of pain management, to improve the quality of pain management in the whole hospital.\u003c/p\u003e \u003cp\u003eThe core indicators of this study provide a tool for pain management in hospitalized patients. However, the monitoring index has not been practiced in other hospitals. In the future, multi-center research and practice should be carried out to continuously evaluate the monitoring effect and improve it The data collection of the index needs the support of a reliable information system. In China, the digital infrastructure of hospitals is different, and there may be some obstacles in the promotion. In the future, efforts should be made towards the establishment of a unified pain monitoring and management index in the country to improve the quality of clinical pain nursing management, and to enhance the consciousness of pain assessment, intervention, and reassessment of nursing staff, to alleviate patients pain, to improve patients satisfaction with pain management.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn this study, six core pain indicators were obtained by the Delphi method, making pain care more standardized and having practical application value. Compared with the evaluation system, the evaluation index is more concise, more convenient to use in clinical practice, more implementable, standardized, and targeted, which can promote the quality of pain care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by the Ethics Committee of Xiangya Hospital of Central South University. Informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYang Zhou conceived and designed the study, performed the analyses, interpreted the data, drafted the first draft, and approved the final manuscript as submitted; Yang Zhou* was involved in data collection and monitoring of the entire study design and facilitated the entire process; Bi-Yun Zeng and Fang-Min Peng were responsible for interfacing with the clinic and providing relevant assistance; and Yabin Guo and Xiaotong Liu were responsible for revising and improving the manuscript. All authors agreed to publish this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Department of Education of Hunan Province, and the science foundation number was 2023JGB043.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all authors for their investment in research design. Thank you also to the medical workers and relevant staff from the hospital information department who participated in the research. They have spent time and energy completing a meaningful job.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGregory J, McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J CLIN NURS. 2016;25(5\u0026ndash;6):583\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi L, Xuping X, Jiping L, Hong Z, Yun B, Jin L. Nursing management in the implementation of the first-time in-patient pain survey in China. Chin J Pain Med. 2015;21(8):630\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Y, Xiao S, Yang H, Lv X, Hou A, Ma Y, Jiang Y, Duan C, Mi W, Yang J, et al. Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. Lancet Reg health Western Pac. 2023;39:100822.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiuli W, Miao HE, Yan Z, Xi W, Haiyan Z. Strategies and effectiveness on improving quality of nursing care for inpatients with moderate to severe pain. Chin Nurs Manage. 2023;23(10):1467\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeissner W, Huygen F, Neugebauer E, Osterbrink J, Benhamou D, Betteridge N, Coluzzi F, De Andres J, Fawcett W, Fletcher D, et al. Management of acute pain in the postoperative setting: the importance of quality indicators. CURR MED RES OPIN. 2018;34(1):187\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck SL, Dunton N, Berry PH, Brant JM, Guo JW, Potter C, Spornitz B, Eaton J, Wong B. Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes. MED CARE. 2019;57(2):159\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiao HE, Xiuli W, Haiou QI, Yang Z, Li LI, Chunxia R, Wenbin J, Jianmei W, Liyuan XU, Minjun L, et al. Survey of pain nursing management status in 145 hospitals of China. Chin Nurs Manage. 2023;23(10):1441\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLei-wen T, Zhi-hong YE, Hong-ying P. Construction of a nursing sensitive quality indicators system. Chin J Nurs. 2013;48(9):801\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeslop L, Lu S. Nursing-sensitive indicators: a concept analysis. J ADV NURS. 2014;70(11):2469\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Tong Y, Cheng Y, Xue Z, Liu M. Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management. PAIN MED. 2020;21(12):3270\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian-wen H, Xiao-ling C, Yun-juan T, Li P, Qiao-li L, Cui-huan H. Li-fen C, Shou-zheng C: Effect of pain management quality indicators on improving quality of pain management in the orthopedic department. Chin J Nurs. 2015;50(02):148\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei W, Fengjuan L, Zhenxiang L, Dong K, Wenhong Z. Construction and clinical application of nursing quality and safety monitoring indexes. J Nurs Sci. 2015;30(3):44\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMędrzycka-Dąbrowska W, Dąbrowski S, Gutysz-Wojnicka A, Basiński A, Kwiecień-Jaguś K. Nurses' Knowledge and Barriers Regarding Pain Management. J PERIANESTH NURS. 2018;33(5):715\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao L, Mu H, Lin Y, Wen Q, Gao P. Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa. J PAIN RES. 2023;16:1767\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRouleau G, Gagnon MP, C\u0026ocirc;t\u0026eacute; J, Payne-Gagnon J, Hudson E, Dubois CA. Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews. J MED INTERNET RES. 2017;19(4):e122.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Huang LH, Xing MY, Feng ZX, Shao LW, Zhang MY, Shao RY. Using the Delphi method to develop nursing-sensitive quality indicators for theNICU. J CLIN NURS. 2017;26(3\u0026ndash;4):502\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePostoperativepain assessment and. nursingin adults-CHINESE NURSING ASSOCIATION(CNA).|.*2024*\u003cem\u003e2024\u003c/em\u003e.; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJinrui C, Ying C. Research progress in nursing-sensitive quality indicators. J Nurs Sci. 2014;29(12):88\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNotice of the General Office of the National Health Commission on Issuing the Performance Assessment Operation Manual for National Third level Public Hospitals. (2023 Edition) _ State Council Departmental Document _ China Government Website.|.*2024*\u003cem\u003e2024\u003c/em\u003e.; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng LX, Patel K, Miaskowski C, Maravilla I, Schear S, Garrigues S, Thompson N, Auerbach AD, Ritchie CS. Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults. J AM GERIATR SOC. 2018;66(9):1744\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiayue C, Yongxing W, Xiaolan Z, Mei G, Bin S. Application of the data processing method for the quantitative variable in nursing quality evaluation. J NURS ADMIN. 2004;4(8):24\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiurong Y, Wenqin Y. The Current Situation and Reflection on the Clinical Nursing Quality Evaluation System. Chin J Nurs 2005(09):697\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi J, Wei S, Gao Y, Mei F, Tian J, Zhao Y, Li Z. Global output on artificial intelligence in the field of nursing: A bibliometric analysis and science mapping. J NURS Scholarsh. 2023;55(4):853\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEpstein RH, Hofer IS, Salari V, Gabel E. Successful Implementation of a Perioperative Data Warehouse Using Another Hospital\u0026rsquo;s Published Specification From Epic\u0026rsquo;s Electronic Health Record System. Anesth Analgesia. 2021;132(2):465\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Delphi method, Pain care, Nursing quality, Nursing sensitive indicator, Information system","lastPublishedDoi":"10.21203/rs.3.rs-4569545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4569545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePain is one of the most common symptoms of hospitalized patients. Currently, the hospital-wide incidence of pain ranges from 37.7% to 84%, and the severity of pain during hospitalization is closely related to the prognosis and the quality of hospital care. Effective and accurate monitoring of pain occurrence and intervention is an indispensable step to improve overall performance and patient satisfaction. Currently, the pain management system in the nursing field has not been integrated with the information system, and there are too many indicators, different grading standards, and clinical generalization is not strong. The existing indicators lack specificity and sensitivity, lack of pain management for hospitalized patients related indicators, prone to the problem of imbalance in pain care management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To construct high-sensitivity, concise, scientific, and easy-to-implement pain management core indicators for hospitalized patients, providing a reference basis for standardizing pain management during hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e First, based on the literature review and hospital evaluation criteria, the core indexes of pain management were collected, screened, and determined, and the framework of the index system was established to form the draft of the core indexes of pain management. Then, core indicators of inpatient pain management were determined by Delphi expert correspondence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTwo rounds of expert consultation were issued 16 questionnaires, all recovered, with a questionnaire response rate of 100%. The results show that the experts are highly motivated. In addition, the average authority coefficient (CR) of 16 experts was 0.972, indicating consistency between expert opinions used and determined. The concordance of the two rounds of expert correspondence was 0.170~0.279 (\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.05), and the range of the coefficient of variation (CV) was 0~0.3, which indicated that the concordance among the members of the expert group was excellent and the results were reliable. After 2 rounds of Delphi expert letters, the final determination of 6 in-patient pain management core indicators, included pain screening rate within 8hours of admission, incidence of Pain, Incidence of moderate to severe pain, intervention rate for moderate to severe pain, reassessment rate of moderate to severe pain, and patient satisfaction with pain management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study Delphi method to identify six key indicators of pain management in hospitalized patients. The indicators were specific, scientific, concise, and useful for clinical practice, the indexes were extracted and monitored automatically, which provided the basis for improving the quality of pain nursing.\u003c/p\u003e","manuscriptTitle":"Development of core pain management indicators for hospitalized patients: a Delphi study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 16:02:31","doi":"10.21203/rs.3.rs-4569545/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93d5b845-8814-4921-96c3-0c7868d62a29","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T06:51:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 16:02:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4569545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4569545","identity":"rs-4569545","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}