Use of visual analogue scale (VAS) and analgesia administration in oncology inpatients: An audit from a tertiary care centre.

Abstract

e24061 Background: Effective pain assessment and timely administration of analgesia are essential components of quality care, particularly in oncology. The Visual Analogue Scale (VAS) is a widely validated, simple tool for quantifying pain intensity and guiding appropriate analgesic selection. However, documentation gaps and delays in analgesic administration may compromise patient comfort and overall treatment experience. This audit was undertaken to evaluate adherence to standardized pain assessment and management practices in the oncology ward of a tertiary care hospital. The aims were to (1) assess the proportion of patients with VAS documented at admission, (2) determine the proportion of patients with VAS ≥ 1 who received timely and appropriate analgesia, and (3) compare findings across three PDSA audit cycles to assess quality improvement. The benchmarks used was 100% of patients should have a VAS documented at admission. Methods: The analysis was conducted from October 4, 2025 to January 10, 2026 as a quality improvement audit of pain management practices in the oncology ward using the WHO analgesic ladder and Visual Analogue Scale (VAS) for pain assessment, structured in a PDSA (Plan–Do–Study–Act) framework. Three PDSA cycles evaluated the impact of repeated education and protocol reinforcement on VAS compliance and WHO ladder adherence. Pain severity and management were categorized according to WHO recommendations: Step 1—non-opioid ± adjuvants for mild pain (VAS 1–3); Step 2—weak opioid ± non-opioid for moderate pain (VAS 4–6); Step 3—strong opioid ± non-opioid for severe pain (VAS 7–10). Results: Across the three PDSA audit cycles (total n = 120), a progressive improvement in pain assessment and management practices was observed (table 1). In the first cycle it was realized that nursing team could not do real time capture of VAS in hospital information system due to logistic challenges. The capture was thereafter changed to a manual system. Conclusions: The audit highlights the critical importance of structured pain assessment and education in improving pain management practices in oncology patients. Progressive improvement in VAS documentation and adherence to the WHO analgesic ladder across consecutive audit cycles demonstrates that regular reinforcement and staff training significantly enhance compliance with pain management protocols. Audits, multidisciplinary engagement, and continued education are essential to achieve consistent, patient-centered pain relief in accordance with WHO standards. Parameter Cycle 1 (n=40) Cycle 2 (n=40) Cycle 3 (n=40) VAS documented, n (%) 26 (65%) 26 (65%) 40 (100%) VAS not documented, n (%) 14 (35%) 13 (32.5%) 0 (0%) Patients with VAS ≥ 1, n (%) 0 (0%) (Documentation error in HIS) 3 (7.5%) 13 (32.5%) Analgesia administered, n (%) 0 (0%) (Documentation error in HIS) 1 (2.5%) 5 (12.5%) WHO ladder adherence Limited Limited Improved