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Quiz for new data collectors (please read SOPs first!)

Dear Research Assistant -

Please go over the following questions. They are derived from information that is found in the PAIN OUT ‘Standard Operating Procedures’ (=SOPs) booklet. Being an international project we can, unfortunately, not work personally with you and teach you the methodological issues associated with data collection. However, as standardized collection of the data is crucial for the project, we produced the SOPs and would like you to become familiar with the information it contains before you begin collecting data from patients. You will receive your username and login once you complete the quiz in a satisfactory manner.

The following questions are not supposed to be difficult or 'trick' questions. They are meant to help you review the items in the SOPs and assist you in the process of data collection.

While filling in the quiz you will probably need to have a copy of the Process questionnaire handy as some of the questions relate to items in this questionnaire.

 

We look forward to having you join PAIN OUT.

Best wishes -

PAIN OUT Coordination Team

Version 2016-04-20

 

 

 

1 The questionnaire is supposed to be anonymous, why is there a box for 'patient code' on every page of the Process and Outcomes questionnaires?

This item will be recorded in the database.
PAIN OUT will supply you with codes to use.
Personnel in each site will create codes for their own use.
The information is for your use only, so that you can keep all forms for a particular patient together.

 

2 The Research Assistant code is:

An item which you should record in the database, for each patient file you create.
A code which is unique to you. It will be given to you by PAIN OUT, once you complete the quiz successfully.
A single code that all research assistants in your site can share.
A code that the person in charge of PAIN OUT in your hospital will give you before you start collecting data.

 

3 In your hospital there is one orthopaedic ward and > 10 surgeries are carried out 3 times a week. How should you go about collecting data?

Wait for the head nurse to contact you and tell you when suitable patients for you to survey are on the ward.
Collect data from as many patients as you have time.
On days you collect data, collect data from ALL patients who comply with the inclusion criteria; if you are restricted for time, create a randomization table and work according to that.

 

4 The variables ‘A. Date of data COLLECTION and  ‘B. Time of data COLLECTION' which are the first you are asked to record in the Process questionnaire and later in the data entry mask

Together with variable ‘P2 Date & Time of END of surgery’, are used to calculate how long after the end of surgery the data was collected from patients.
They should not be confused with date and time of data ENTRY.

 

5 It is 20:00, you have just finished your shift in the Operating Room. You would like to start collecting data for PAIN OUT. Can you set out to do this?

Yes, you need to collect data whenever you have an opportunity to do so.
No, patients can be approached for recruitment between 08 – 18.

 

6 You work as an anaesthetist or nurse on the Acute Pain Service (APS) and also collect data for PAIN OUT.  What should you pay special attention to?

It will be nice for you to meet the patients you treated and get their feedback as to how they are feeling.
You do not collect data from patients that you treated (as much as is technically possible in your hospital).
Data from APS patients can be collected for PAIN OUT.

 

7 Surgery ended at 2 am; it is now 14:00 and the patient has been back on the ward since 8 am. Can this patient be recruited?

No, the patient is POD 0
Yes, the patient has been back on the ward for more than 6 hours.
Wait until the following day.

 

8 The patient fulfils S1 and S2 but is not in his room. What should you do?

Fill in the Process questionnaire only.
Select S3.a (=Patient is not on the ward) and stop the process of recruiting this patient.
Leave the Outcomes questionnaire with a nurse, ask her to give it to the patient when he is back and say you will come to pick it up later.

 

9 The patient is alert, communicable, but the font of the Outcomes questionnaire is too small for her to see. The patient has a family member who wants to help. What should you do?

Thank the family member for her help and ask her to read the questions out loud to the patient and fill in the answers according to what the patient reports.
Thank the family member for her help, ask if she could possibly leave the room for about 10 minutes; you read the questions out loud to the patient, fill in the answers according to what the patient reports.
If she needs this sort of help, the patient is not suitable for the survey.
Mark that the patient was interviewed and reason for this at the end of the Outcomes questionnaire.

 

10 The patient is a 30 year old male, looks comfortable to you; he has just filled in Outcomes questionnaire. The patient has marked '9' for 'worst since surgery’.  Your response will be:

You think that this answer does not represent the intensity of pain that the patient experienced, and so you say to him: 'I see you marked that you have severe pain, are you sure this is what you meant to mark, do you want to reconsider?'
Go over the questionnaire to make sure that all the questions have been filled in and ask him if he had any problems with any of the questions.
You change the assessment to ‘3’.

 

11 The patient fulfils Screening criteria S1 & S2 but can communicate in Norwegian only (as an example of a language that might rarely be spoken in your hospital), what should you do?

Try and get a family member or member of staff to translate the questionnaire and fill in the answers.
Try to explain the questions to the patient yourself.
Fill in the Process questionnaire only.
Check the PAIN OUT website to see if a Norwegian version of the Outcomes questionnaire is available for download; if it is not, exclude the patient in S3.e.

 

12 When you enter the room, the patient is sleeping. If you decide to let him sleep, what  will your next steps consist of?

 

Exclude him in S3.c. (=Patient is asleep)
Leave the Outcomes questionnaire next to him so that he can fill it in when he wakes up and plan to come back after about an hour to pick it up.
Fill in the Process questionnaire

 

13  You are working in a hospital in London, the patient is Italian, but is currently living in the UK. The patient complies with screening criteria S1 - S3. Which language of the Outcomes questionnaire will you choose to give him?

The English version. His spoken English was good.
Ask him which language he would prefer to fill in the questionnaire, Italian or English, and if he prefers the Italian, download it from the PAIN OUT website.
Give him the English version and ask a nurse to help the patient with the words he is not familiar with, while you leave the room.
Give him the English version and help him with the words which are not familiar to him.

 

14 The patient fulfils screening criteria S1 & S2, after you introduce yourself and the survey, the patient says that he is not interested in participating in the survey. What will you do?

Tell him it will only take 10 minutes of his time, that his answers might be of great use in helping to improve management of pain of other patients in future.
Thank him for his time and leave the room.
In S3.b mark 'Patient does not wish to participate“
Ask a family member or friend to try and persuade the patient to fill in the questionnaire, stressing that it will only take 10 minutes of his time and should help staff to improve treatment in the department.

 

15 It is 17:30, the patient fulfils screening criteria S1 & S2 and the patient gives his consent to participate in the survey. However, visitors have just arrived and can not stay for long. The patient asks you to leave the Outcomes questionnaire for him to fill in later. What will you do?

Leave the questionnaire with the patient and come back as soon as you get in to work the following day.
Say that the patient needs to fill in the questionnaire with no help and could the guests leave the room for 10 minutes and that you will come back in 1 hour to pick up the questionnaire.
Ask the guests to help the patient fill in the questionnaire; giving them a bit more time to spend together

 

16 A patient received anesthesia with remifentanil and propofol together with small boluses of midazolam. How should you record this?

In M4, select 'YES' for general anaesthesia and then 'IV'.
Select Remifentanil in the IV column in 'M8 Opioids & local anaesthetics '.
Write 'propofol' in 'Other, specify' in the IV column M8
Write 'midazolam in the 'Other, specify' in the IV column M8
In the intra-operative period, PAIN OUT records only analgesics (opioids, local anaesthetics, non-opioids) and adjuncts, clonidine and dexamethasone but not anxiolytics or sedatives

 

17 The patient received epidural ropivacaine with fentanyl during surgery. Which boxes will you tick?

Can not be done, there is no option for 'epidural' in 'M8 Opioids & local anaesthetics'.
In M5 (Regional Anesthesia, intra-op): tick ‘yes’ and epidural
In M8: tick fentanyl and ropivacaine in the RA column

 

18 The surgeon infiltrated the patient's wound with bupivacaine before suturing the wound. Which box(s) will you tick?

'M7 Wound infiltration (intra-op)' only
M7 AND the medication in M8
Do not record the name of medication(s) given for infiltration

 

19 The patient is in the recovery room. He has an order for IV morphine 5mg every 10 minutes up to 20 mgs. The patient received 10 mgs. What will you record in M11?

10mg
20mg

 

20 In PAIN OUT, 'duration of surgery' is defined as:

Time from start to end of surgery.
Time from start to end of anesthesia.

 

21 The patient received IV midazolam 5mg in the recovery room. What should you do?

Nothing, do not record sedatives and anxiolytics given in the recovery room.
Write 'midazolam' in the 'other' box in M9 'non-opioids recovery room'.

 

22 You would like to carry out a small study in your centre about the effect of light on post operative pain. Which are the most reasonable option(s)?

Can not be done within the framework of PAIN OUT.
Use the blank fields on page 1 of the Process questionnaire.
Contact the PAIN OUT coordinators and suggest this as a sub-study; the coordinators are keen that people initiate projects within the framework of the larger project.

 

23 You have come to collect the Outcomes questionnaire from a patient and find that 5 questions have been left un-answered. The patient does not understand the meaning of these questions. You repeat the text of each question but the patient is still unable to answer 3 of them. What should you do?

Keep trying to clarify the 3 questions; the questions are not difficult to understand.
Ask the patient to leave the 3 questions un-answered.
Suggest answers that seem correct to you, and ask the patient whether he agrees with your proposals.

 

24 The patient fulfils Screening criteria S1 and S2. When you come to ask for consent, the patient is not interested, saying he is in too much pain. Other than thanking him for his time and excluding the patient, what can you do?

 

Ask a family member to persuade the patient to give his consent, saying that by filling in the questionnaire he might help other patients in the future.
Offer to assist the patient by reading the Outcomes questions out loud and marking his answers on the sheet
At the end of the Outcomes questionnaire record that the questionnaires were answered as an interview and mark that the patient was in ‘Too much pain’.

 

25 In your hospital, remifentanyl is often used and given as a continuous infusion, the actual dose changes at regular intervals throughout surgery.
In light of the sections related to recording medications in the SOPs,  which is the better strategy for recording remifentanyl in 'M8 Opioids & local anaesthetics (intra-op)'?

 

Record name of medication, route it was given and calculate the dose given by adding up the doses administered throughout surgery.
Record the name of the medication and route it was given and NOT the dose
It is vital to record the dose of a medication whenever possible
Better to leave out dose if it requires time to calculate and some likelihood of making a mistake in the calculation

 

26 The patient has an epidural PCA with a continuous (background) infusion of fentanyl and an option for a bolus every 8 minutes. He was hooked up to the pump in recovery (or Post Anesthesia Care Unit) and has been back on the ward for 10 hours.
In light of the sections related to recording medications in the SOPs, which is the better strategy for recording the medication?

(a) How will you record this for recovery

In M10, select ‘epidural’
In 'M11 Opioids & local anaesthetics (recovery room)', select the RA column and tick the box associated with fentanyl, make no record of the actual dose given, and tick the corresponding PCA box.
To calculate the dose, check the pump settings for the number of boluses and check how long the patient has been receiving the infusion. Add these up and write the dose in the RA column associated with fentanyl in M11
Better to leave out the dose if it requires time to calculate it and some likelihood of making a mistake in the calculation

 

(b) How will you record this for the ward?

In M13, select ‘epidural’
In M14 'Opioids & local anaesthetics', select the RA column and tick the box associated with fentanyl, make no record of the actual dose given, and tick the associated PCA box
Check the pump for number of boluses and how long the patient received the infusion on the ward. Add these up and write the dose in M14, in the RA column, in the fentanyl box

 

27 The patient’s intake notes were taken hurriedly, a number of comoribdities are listed but in very little detail. What should you do?

Approach the patient and ask for more details.
Use what information is available in the medical record.

 

28  In question H2 you are asked to record whether the patient is pregnant and or lactating.
(a) You are filling in the Process questionnaire for a 30 year old female. What should you do?

Check her medical file to see whether this information is recorded, if this not mentioned, select the ‘not possible to obtain the information’ option
Ask her
Tick the ‘not relevant’ option

 

(b) You are filling in the Process questionnaire for a 70 year old female.
What should you do?

Check her medical file to see whether this information is recorded, if this not mentioned, select the ‘not possible to obtain the information’ option.
Ask her
Tick the ‘not relevant’ option

 

29 The ICD-9 code for Transurethral (ultrasound) guided laser induced prostatectomy (TULIP) is:

ICD

 

30 The ICD-9 code for Unilateral breast implant is

ICD:

 

31 Which statement is true with regards to recording comorbidites in PAIN OUT?

In H1 you should register all comorbidities listed in the patient’s medical record
Register ‘cancer’ as a comorbidity in H1 if you find the term 'cancer' or synonymous terms such as malignancy, malignant neoplastic disease, malignant tumor, or neoplasm, in the medical file.
In PAIN OUT, a comorbidity refers to a condition which might strongly impact on how a patient's pain is managed after surgery
Comorbidities might not be recorded reliably in the patient’s medical record; in such cases, please ask the patient to provide this information.
A comorbidity listed as text in under ‘Other’ will rarely be assessed and so it should be recorded ONLY if you or the Principal Investigator in your site, have defined this as relevant information for your site
Write the comorbidity in ‘Other’, only after you have made sure it is not already listed in the table

 

32 When collecting the patient questionnaire, what should you look out for?

If a patient left a question(s) un-answered, you assume that this is intentional and no further action is necessary
Look over the questionnaire to assess whether all questions have been filled in.
If you find question(s) that were not filled in, ask the patient if this is intentional or would he / she like to answer the question(s)

 

33 When entering data into the web-based mask, what should you look out for?

Other than for the Screening tab, if you miss entering data, you will be alerted by a warning message.
The data is sorted according to the surgical code and so it does not matter which of the benchmark groups allocated to your hospital, you use for entering data.
Once you have entered data for one patient, review each section (Or TAB) to confirm that all the items have been filled in.
A file is accessible for editing for 8 weeks, after which editing is not possible
You should make sure you are entering data into the correct benchmark group

 

34 H.G. received single shot regional anesthesia with an opioid and local anaesthetic. How should you record this in 'M10 Regional analgesia (recovery room)'?

The medications are still having an effect and so mark ‘YES’ and select the type of block.
The injection was a single shot i.e. medication is no longer being administered and so select 'NO'

 

35 P.J. was anaesthetized via an epidural. In Recovery she was connected to a PCA pump and allowed use boluses via the epidural catheter. How should you record this?

The catheter remains in place and medication can be infused via boluses and so you should select ‘YES’ in M10 Regional analgesia (recovery room)
In M11 'Opioids & local anaesthetics', select the name of the medication in the RA column AND tick the corresponding PCA box
If the calculation is complex and / or time consuming there is no need to calculate the dose infused as boluses.
In M10 Regional analgesia (recovery room), select 'epidural' as the type of block
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