Claire Hatherley1, Natasha Jennings2, Rachel Cross3. 1. Cabrini Institute - Education & Research Precinct, Cabrini Health, 154 Wattletree Road, Malvern, Victoria 3144, Australia; Emergency & Trauma Centre, The Alfred Hospital Commercial Road, Prahran, Victoria 3004, Australia. Electronic address: C.Hatherley@alfred.org.au. 2. Emergency & Trauma Centre, The Alfred Hospital Commercial Road, Prahran, Victoria 3004, Australia. 3. Alfred Clinical School La Trobe University, School of Nursing and Midwifery, Victoria 3004, Australia; Emergency & Trauma Centre, The Alfred Hospital Commercial Road, Prahran, Victoria 3004, Australia.
Abstract
BACKGROUND: Emergency Department pain management is an often overlooked aspect of acute care and is of paramount importance. Patients are often forced to wait extended periods of time without pain assessment or being offered analgesia for their painful condition. This has been associated with poor psychological and physiological consequences both for the health system and the patient. This is suggestive of a lack of clarity around best practice standards for time to analgesia and pain score documentation in the ED. METHODS: A literature review was undertaken to investigate best practice in relation to acute pain management. Key outcomes were pain score documentation and time to analgesia. After a search of the electronic databases, a total of 992 abstracts were screened and 38 potentially relevant full articles were reviewed. There were 23 articles excluded for a variety of reasons including poor methodology, indirect specialty and inappropriate focus or age of study. A total of 15 studies were appropriate for inclusion in the review. RESULTS: Of the 15 studies, only eight included pain score as an outcome and 13 used time to analgesia as a measure. Four studies specifically investigated nurse initiated analgesia programs in relation to improving acute pain management. A higher incidence of pain assessment, reassessment and pain score documentation was generally correlated with decreased time to analgesia. CONCLUSIONS: Whilst there is an abundance of evidence available on the current practice and challenges of quality acute pain management in the ED, there is a lack of well-controlled studies on best practice standards for health care services to benchmark their practice and improve. Mandating pain score reporting, pain assessment and reassessment within specific timeframes and analgesia administration within 30 min of arrival is highly recommended. The implementation of nurse led analgesia protocols should be encouraged to increase incidence of documented pain assessment and reduce time to analgesia.
BACKGROUND: Emergency Department pain management is an often overlooked aspect of acute care and is of paramount importance. Patients are often forced to wait extended periods of time without pain assessment or being offered analgesia for their painful condition. This has been associated with poor psychological and physiological consequences both for the health system and the patient. This is suggestive of a lack of clarity around best practice standards for time to analgesia and pain score documentation in the ED. METHODS: A literature review was undertaken to investigate best practice in relation to acute pain management. Key outcomes were pain score documentation and time to analgesia. After a search of the electronic databases, a total of 992 abstracts were screened and 38 potentially relevant full articles were reviewed. There were 23 articles excluded for a variety of reasons including poor methodology, indirect specialty and inappropriate focus or age of study. A total of 15 studies were appropriate for inclusion in the review. RESULTS: Of the 15 studies, only eight included pain score as an outcome and 13 used time to analgesia as a measure. Four studies specifically investigated nurse initiated analgesia programs in relation to improving acute pain management. A higher incidence of pain assessment, reassessment and pain score documentation was generally correlated with decreased time to analgesia. CONCLUSIONS: Whilst there is an abundance of evidence available on the current practice and challenges of quality acute pain management in the ED, there is a lack of well-controlled studies on best practice standards for health care services to benchmark their practice and improve. Mandating pain score reporting, pain assessment and reassessment within specific timeframes and analgesia administration within 30 min of arrival is highly recommended. The implementation of nurse led analgesia protocols should be encouraged to increase incidence of documented pain assessment and reduce time to analgesia.
Authors: Stefan J Friedrichsdorf; Andrea C Postier; Gail S Andrews; Karen Es Hamre; Rose Steele; Harold Siden Journal: J Pain Res Date: 2017-07-31 Impact factor: 3.133
Authors: Hyung Lan Chang; Jin Hee Jung; Young Ho Kwak; Do Kyun Kim; Jin Hee Lee; Jae Yun Jung; Hyuksool Kwon; So Hyun Paek; Joong Wan Park; Jonghwan Shin Journal: Clin Exp Emerg Med Date: 2018-03-30