| # | Question Content | N | L0 | L1 | L2 | L3 | L4 | L5 | L6 | L7 | L8 | L9 | L10 | Num | Den | Rate | Low | High |
| Patient Pain Assessment |
| 2 | How much pain are you having right now? | 2 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 15 | 22 | 68.2% | 48.7% | 87.6% |
| 100% | 0.0% | 0.0% | 0.0% | 50.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 3 | Please indicate the worst pain you have had in the past 24
hours? | 2 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 11 | 22 | 50.0% | 29.1% | 70.9% |
| 100% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 50.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 4 | Please indicate the average level of pain you have had in the past 24
hours. | 2 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 14 | 22 | 63.6% | 43.5% | 83.7% |
| 100% | 0.0% | 0.0% | 0.0% | 50.0% | 0.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| Has Pain Affected Patient Activity in the Past 24 Hours |
| 5A | During the past 24 hours, pain has interfered with
your general activities. | 2 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 19 | 22 | 86.4% | 72.0% | 100.0% |
| 100% | 50.0% | 0.0% | 0.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 5B | During the past 24 hours, pain has interfered with your
mood? | 2 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 18 | 22 | 81.8% | 65.7% | 97.9% |
| 100% | 50.0% | 0.0% | 0.0% | 0.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 5C | During the past 24 hours, pain has interfered with your
walking ability? | 2 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18 | 22 | 81.8% | 65.7% | 97.9% |
| 100% | 0.0% | 50.0% | 0.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 5D | During the past 24 hours, pain has interfered
with your relations with the others? | 2 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 19 | 22 | 86.4% | 72.0% | 100.0% |
| 100% | 50.0% | 0.0% | 0.0% | 50.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 5E | During the past 24 hours, pain has interfered with your
general sleep? | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 8 | 22 | 36.4% | 16.3% | 56.5% |
| 100% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 0.0% | 0.0% | 0.0% | | | | | |
| 5F | During the past 24 hours, pain has
interfered with your other activities that are needed to recover from illness? | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 5 | 11 | 45.5% | 16.0% | 74.9% |
| 100% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 0.0% | 0.0% | 0.0% | 0.0% | | | | | |
| Patient Satisfaction with Pain Management |
| 6 | Select the phrase that indicates how
satisfied or dissatisfied you are with the result of your pain treatment overall. | 2 | | 0 | 0 | 0 | 0 | 2 | 0 | | | | | 10 | 12 | 83.3% | 62.2% | 100.0% |
| | | 100% | | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 0.0% | | | | | | | | | |
| 7 | Select the
phrase that indicates how satisfied or dissatisfied you are with the way your nurses
responsed to your report of pain. | 2 | | 0 | 0 | 0 | 0 | 2 | 0 | | | | | 10 | 12 | 83.3% | 62.2% | 100.0% |
| | | 100% | | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 0.0% | | | | | | | | | |
| 8 | Select the phrase
that indicates how satisfied or dissatisfied you are with the way your physicians responsed to your report of pain. | 2 | | 0 | 0 | 0 | 0 | 2 | 0 | | | | | 10 | 12 | 83.3% | 62.2% | 100.0% |
| | | 100% | | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 0.0% | | | | | | | | | |