Increased analgesia administration in emergency medicine after implementation of revised guidelines.

Geesje Van Woerden,Diana C Grootendorst,M Christien Van Der Linden,Cornelis F Den Hartog,Crispijn L Van Den Brand,Floris J Idenburg

doi:10.1186/s12245-016-0102-y

Geesje Van Woerden, Diana C Grootendorst + Show 4 more

Open Access

https://doi.org/10.1186/s12245-016-0102-y

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Abstract

BackgroundThe most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management.MethodsWe conducted a prospective pre-post intervention cohort study with implementation of a revised guideline for pain management at our ED, in which nurses are allowed to administer analgesia (including low-dosage piritramid (opioid) intravenous) without doctor intervention. Numeric Rating Scales (NRS) were measured, and administration of medication (main outcome) was documented. We included every adult patient presenting with pain (NRS 4–10) at the ED.ResultsA total of 2107 patients (1089 pre-implementation phase and 1018 post-implementation phase) were included in our study. During pre-implementation, 25.4 % of the patients with NRS between 4 and 10 received analgesia. After implementation, 32.0 % of these patients received analgesia (p < 0.001).ConclusionsAfter implementation of the revised guidelines in pain management at the ED, the administration of pain medication increased significantly. Nevertheless, the percentage of patients in pain receiving analgesia remain low (32 % after implementation).

Highlights

IntroductionThe objective of this study is to determine whether the administration of analgesia at the emergency department (ED) increases by implementation of revised guidelines in pain management
The most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases
Characteristics of study subjects Patients enrolled in the two phases of the study were similar with regard to age, gender and ethnicity (Dutch or other)

Summary

Introduction

The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management. The treatment of pain at the ED is suboptimal and oligoanalgesia remains common [2]. The Numeric Rating Scale (NRS) to categorise pain as rated by physicians and nurses are both significantly lower than those reported by the patients [3, 4]. Lack of knowledge and lack of guidelines in pain management contribute to the Importance improvement of knowledge (among nurses and doctors) and revision of guidelines may increase the administration of analgesia

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