scholarly journals Quality improvement activity for improving pain management in acute extremity injuries in the emergency department

2018 ◽  
Vol 5 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Hyung Lan Chang ◽  
Jin Hee Jung ◽  
Young Ho Kwak ◽  
Do Kyun Kim ◽  
Jin Hee Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pain Management ◽  
Quality Improvement Activity ◽  
Extremity Injuries

Improving Pain Management Knowledge Among Nurses

2018 ◽  
Vol 3 (7) ◽  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pain Management ◽  
Pain Assessment ◽  
Quality Improvement Project ◽  
Project Implementation ◽  
Improvement Project ◽  
Emergency Department Nurses ◽  
Management Knowledge ◽  
Improve Patient

Pain is the most commonly presented symptom among patients who are admitted to the emergency department. Unfortunately, many barriers to pain management exist thereby impacting emergency department patient care and outcomes, specifically regarding inadequate pain assessment, reassessment, and documentation. Thus, the quality improvement project aimed to increase emergency department nurses knowledge of pain management and utilization of pain assessment guidelines, resources, and policies. By nurses having sufficient education, they can provide timely and efficient care to support patient outcomes, improve patient comfort, and improve patient satisfaction. The Knowledge and Attitudes Survey Regarding Pain was utilized to conduct a pre and post-test assessment to measure emergency department nurses’ knowledge of pain management [1]. The results of the quality improvement project showed that nurses lacked adequate pain management knowledge, 45.45% of participants responded incorrectly to knowledge questions about pain before the intervention. However, after the project implementation, the results of the data analysis showed a statistically significant mean increase of 23.91% from pre-intervention (65.65%) to post-intervention (89.56%) after eight weeks of project implementation. This quality improvement project will provide a basis for future studies in improving nurses’ pain management knowledge.

Quality Improvement Goals for Sickle Cell Disease Pain Management in an Urban Pediatric Emergency Department: We Can Do Better!.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2101-2101 ◽  
Author(s):  
Claudia R. Morris ◽  
Fernando Barreda ◽  
Sara A. Leibovich ◽  
Mary Rutherford ◽  
Augusta Saulys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Placebo Control ◽  
Cell Disease ◽  
Patient Acuity ◽  
Ed Visits

Abstract Abstract 2101 Background. Vaso-occlusive painful episodes (VOE) are the leading cause of hospitalizations and emergency department (ED) visits in sickle cell disease (SCD), and are associated with increased mortality. Although disparities specific to pain management practices in the ED for children with SCD have not been identified, ethnic disparities in ED care have been reported, & adults with SCD experience longer delays in the initiation of analgesics compared to other patients with pain. However, initiation of treatment in the ED is often delayed as a result of random events that are beyond anyone's control, such as high patient volumes & acuity of other patients in the ED, even when policies are in place for immediate triage of patients with SCD & pain. In a recent study of children with SCD, median time from arrival to analgesia administration was 90 minutes, with high ED census as the biggest culprit for delays. Barriers to rapid care in the ED are common across the country, including overcrowding, nursing ratios, insufficient staff coverage, inadequate funding, & slow flow of patients from the ED to the wards in addition to patient acuity. Methods. As part of a quality improvement (QI) project to improve management of SCD pain in the ED at Children's Hospital & Research Center Oakland, we are reviewing quality indicators to determine areas that can be targeted for improvement. ED-based data was collected and analyzed from a sample of 47 patients initially evaluated in the ED and enrolled in a randomized, placebo-control trial of argininetherapy for children with SCD hospitalized for VOE between years 2000–2008, and compared to recent data in 2012 of 55 ED visits for VOE (66% admissions) to identify trends in practice in our ED. Results. See Table 1. Conclusions. To these authors' surprise, children with SCD commonly experienced delays in pain management in the ED. These trends have not changed dramatically over a decade, and are not likely to be unique to our facility. Areas to target for improvement include time of arrival to parenteral pioid administration, in particular, time from ED room placement to placement of intravenous catheter. Utilizing intranasal fentanyl in the ED for acute pain is one novel intervention that should significantly decrease time to initial pain management. These reported data will be used as baseline quality measures for comparison to determine the success of QI initiatives such as a refined pain management algorithm on ED-based clinical outcomes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Resident-Led Quality Improvement Initiative to Optimize Care for Children and Young Adults with Sickle Cell Disease Vaso-Occlusive Pain with Intranasal Fentanyl in the Emergency Department

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1892-1892
Author(s):  
Wilson Andres Vasconez Samaniego ◽  
Cristina Matheus ◽  
Claudia Aguilar-Velez ◽  
Prasanth Narahari ◽  
Priyanka Nair ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Clinical Pathway ◽  
Cell Disease ◽  
First Line ◽  
Discharge Time ◽  
Dose Time

Abstract Background: Sickle cell disease (SCD) is an inherited blood condition that predisposes affected patients to severe vaso-occlusive (VOC) pain events. The NHLBI (last revised in 2014) and ASH guidelines (last revised 2020) recommend a door-to-first dose should be within 60 minutes vs. 30 minutes from registration, and reassessment and re-administration of medications should be every 30 minutes. Non-IV routes of administration, i.e. intranasal (IN) can facilitate rapid analgesic treatment. Recent studies have shown IN Fentanyl as an effective pharmacological strategy to treat vaso-occlusive pain episodes. Methods: This resident-led Quality Improvement specific aim was to reduce the meantime from check-in to first analgesic delivery to SCD patients with VOC presenting to the Pediatric Emergency Department (PED) by at least 20% during 12 months and to improve the overall care of SCD VOC in accordance to best practices. PDSA cycle methodology was utilized to identify root causes, countermeasures, and key drivers (Figure 1A). We implemented a SCD VOC clinical pathway for PED providers to utilize our enhanced and updated version of an electronic order set named "PED Sickle Cell Crisis Power Plan" that includes IN Fentanyl as first-line therapy for SCD VOC. IRB approval was obtained. PED nursing staff was trained to administer IN Fentanyl with a nasal mucosa atomizer. Exclusion criteria of patients with SCD with other ICD-10 diagnosis codes, i.e pain not associated with VOC. The main indicators were assessment-to-dose time; registration-to-discharge time; first dose-to-discharge time, and rate of VOC admissions. Data was collected by discrete-time stamps and statistically analyzed using Excel 365. The analysis compared baseline with initial PDSA cycles from December 2019 to February 2020, and from September 2020 to March 2021. Results: From September 2020 to February 2021, a total of 54 encounters for SCD VOC qualified clinically to receive IN Fentanyl. A total of 49 of these encounters received this medication, while 5 refused its administration. Patient demographics: Male-to-female ratio was 53% and 47%, respectively. The majority of the patients seen were adolescents (63% with ages between 12-21 years). African-American participants represented 88% and non-Hispanics 84%. After our interventions, 94% of encounters have documented pain reassessment in their electronic medical records. IN Fentanyl was first introduced in the PED in September 2020, and became the first medication to be administered in 94% of the encounters. The average length of stay in the PED was 269 minutes (4 hrs. with 29 minutes). The SCD VOC Clinical Pathway was used in 90% of the encounters and the SCD VOC Power Plan was used in 80% of them. From the total of encounters, 59% required admission to the floor for further pain management strategies. As shown in the control chart (Figure 1.B), the meantime from check-in to first analgesic delivery to patients with VOC presenting to the PED was reduced to under 40 minutes by February 2021. After the implementation of IN Fentanyl, there is an overall improvement of the waiting time for administration of medications of more than 70 minutes (from 138 min down to 67 minutes). Most importantly, 37% (18/49) of SCD VOC events were discharged after successful VOC pain management in the PED. Discussion: PED staff surveys demonstrated a lack of familiarity with current VOC guidelines and a standardized pathway. Medication refusal of IN Fentanyl was found to be related mostly to patient preference, poor knowledge about side effects, and parental fear for oversedation before our interventions. Conclusion: A multi-disciplinary team was formed to assist health care providers in the ED to deliver optimal care to patients with SCD based on the current evidence-based SCD VOC clinical pathway and efficient pharmacological intervention with IN Fentanyl. Standardized procedures to treat and reassess pain for SCD VOC patients in the PED resulted in check-in to first-dose time reduction by 47%. There was a consistent improvement in Length of Stay in the PED, which decreased more than 60 minutes (from 5 hrs. 21 min. to 4 hrs. 29 min). There is a significant improvement of quality in the care of VOC including 1. Pain scoring system. 2. Documented pain reassessment. 3. Use of a multidisciplinary reviewed protocol that includes PED SCD VOC clinical pathway, and an updated order set power plan with IN Fentanyl as the first line. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul Owono Etoundi ◽  
Junette Arlette Metogo Mbengono ◽  
Ferdinand Ndom Ntock ◽  
Joel Noutakdie Tochie ◽  
Dominique Christelle Anaba Ndom ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Pain Management ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices

scholarly journals Commonly Used Agent for Acute Pain Management of Sickle Cell Anemia in Saudi Emergency Department: a Narrative Review

2021 ◽  
Author(s):  
Reem A. Hejazi ◽  
Nameer A. Mandourah ◽  
Aryaf S. Alsulami ◽  
Hussain T. Bakhsh ◽  
Reem M. Diri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Acute Pain ◽  
Narrative Review ◽  
Acute Pain Management
Sign in / Sign up

Export Citation Format

Share Document