scholarly journals Pain management in the emergency department: results from an observational longitudinal prospective study in a second-level urban hospital

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Anna Giulia Falchi ◽  
Anna Spadoni ◽  
Chiara Blatti ◽  
Federica Manzoni ◽  
Stefano Perlini
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Prospective Study ◽  
Nursing Staff ◽  
Emergency Care ◽  
Present Status ◽  
Pain Control ◽  
Urban Hospital ◽  
Pain Evaluation ◽  
Assessment And Treatment

Although a correct assessment of pain and an adequate analgesia represent a priority in the setting of emergency care, many studies documented an inadequate pain control. The purpose of our study is to characterize the present status of a second level Emergency Department in Italy in terms of pain assessment and treatment. Our survey investigates the multidimensional aspects of pain, the accomplishment of appropriate pain evaluation by the medical and nursing staff and the effectiveness of the treatment, in terms of pain reduction and also of customer satisfaction.

A Prospective Study of Pain Control in the Emergency Department

2000 ◽  
Vol 7 (4) ◽  
pp. 251-255 ◽  
Author(s):  
Jeffrey F. Barletta ◽  
Brian L. Erstad ◽  
Michael Loew ◽  
Samuel M. Keim
Keyword(s):  
Emergency Department ◽  
Prospective Study ◽  
Pain Control ◽  
A Prospective Study

scholarly journals An Interactive Pain Application (MServ) Improves Postoperative Pain Management

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Richard Gordon-Williams ◽  
Andreia Trigo ◽  
Paul Bassett ◽  
Amanda Williams ◽  
Stephen Cone ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Nursing Staff ◽  
Pain Control ◽  
Standard Care ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Pain Scale ◽  
Opioid Prescription ◽  
Patient Reported

Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.

Pain management in persons with intellectual disabilities living in institutions

2020 ◽  
Vol 33 (1) ◽  
pp. 35-39
Author(s):  
G. Pickering ◽  
A. Boyer ◽  
N. Danglades ◽  
S. Arondo ◽  
C. Lucchini ◽  
...  
Keyword(s):  
Pain Management ◽  
Intellectual Disabilities ◽  
Pain Assessment ◽  
Healthcare Professionals ◽  
Opioid Analgesic ◽  
Pain Evaluation ◽  
Vulnerable Patients ◽  
Assessment And Treatment ◽  
Effective Assessment ◽  
Pain Care

Background: Persons with severe intellectual disabilities often live in specialised care settings and suffer from comorbidities, some of them generating pain. The literature concerning pain assessment and management in this population is however limited. The main objective of this study was to determine the modalities of pain care in a sample of French institutions. Methods: This observational study focused on the modalities of pain assessment and management in six specialised care settings for persons with intellectual and/or psychomotor disabilities. Information about patients, pain evaluation, prevalence and how do healthcare professionals assess pain in noncommunicating intellectually disabled people was recorded. Results: The study included 218 residents and over the last month, 55% had pain, 87% suffered from acute pain and 16% from neuropathic pain. The use of pain scales for patients with communication impairment was unknown to the majority of healthcare professionals. Patients were prescribed 4 drugs a day, 68% had psychotropic drugs and over the last month, 98% of painful residents had received a non-opioid analgesic combined with a non-pharmacological technique in 78 % of them. Conclusion: Pain management must be carried out through accurate pain assessment and the limited knowledge of caregivers about pain assessment methods might contribute to insufficient pain care. It is necessary to train all caregivers about pain evaluation tools that must be adapted to the disability profile of the residents in order to provide the most effective assessment and treatment in these vulnerable patients.

Quality of pain management in the emergency department: results of a multicentre prospective study

2011 ◽  
Vol 28 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Sophie Guéant ◽  
Ariski Taleb ◽  
Jocelyne Borel-Kühner ◽  
Maxime Cauterman ◽  
Maurice Raphael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Prospective Study ◽  
Multicentre Prospective Study

scholarly journals Improving the Treatment and Assessment of Moderate and Severe Pain in a Pediatric Emergency Department

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Roger Chafe ◽  
Debbie Harnum ◽  
Robert Porter
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Focus Group ◽  
Severe Pain ◽  
Pain Treatment ◽  
Pediatric Emergency ◽  
Standards Of Care ◽  
Treatment Protocols ◽  
Assessment And Treatment ◽  
The Impact

Background.The Janeway Children’s Hospital previously enacted a number of measures to improve pain management for patients in its emergency department (ED). While improvements were demonstrated, rates for the timely assessment and treatment of pain remain below standards of care.Objectives.The study objectives are to investigate the impact of the previous attempts to improve the treatment of pain and to explore ways to further improve pain management in the ED.Methods.Key informant interviews and a focus group were conducted with nurses, physicians, and parents whose children were identified as having severe pain.Results.Interviews were conducted with 31 parents or children, 9 physicians, and 8 nurses. The focus group was attended by 15 nurses. Previous initiatives were viewed as improvements. Continued barriers include difficulties in accurately capturing the level of pain, issues in treating pain for specific types of patients, and inadequacy in addressing patients in severe pain.Conclusion.Changes in pain treatment protocols can result in positive impacts but are likely insufficient on their own to achieve desired standards of care. Consistent measurement and engagement with staff can identify additional opportunities for improving pain management within an ED setting.

scholarly journals Optimizing Pain Management for Children with Sickle Cell Disease Vaso-Occlusive Crisis in the Emergency Department

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 44-44
Author(s):  
Wilson Andres Vasconez ◽  
Claudia Aguilar-Velez ◽  
Cristina Matheus ◽  
Marie Anne Sosa ◽  
Yvonne Diaz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Nursing Staff ◽  
Clinical Pathway ◽  
Current Evidence ◽  
Cell Disease ◽  
Discharge Time ◽  
Dose Time

Background: Sickle cell disease (SCD) is an inherited blood disorder that predisposes affected children to episodic pain events, known as the Vaso-occlusive crisis (VOC). VOC is the most common reason for emergency department (ED) visits in patients with SCD. This QI project-specific aim was to assess the meantime from check-in to first analgesic delivery to patients with VOC presenting at Holtz Children's Hospital Pediatric Emergency Department (PED) and to reduce this time by at least 20% (from 90 minutes to 72 minutes) during six months in accordance to best practice standard of care. Methods: Standard quality improvement tools and PDSA methodology was utilized to identify root causes and countermeasures. Root cause analysis included surveys from PED staff, residents, and faculty which demonstrated a lack of practitioner familiarity with current evidence and lack of a standardized pathway. Using this data, countermeasures were implemented, including staff education of guidelines, creation, and deployment of a readily accessible SCD VOC clinical pathway (Figure 1) for PED providers to utilize an updated electronic order set "power-plan" named PED Sickle Cell Crisis Powerplan. A balancing measure while we attempt to reduce the time to first analgesic administration, can be an increase in workload for the nursing staff in the PED. A PED orientation introductory email prompted residents to use our clinical SCD VOC pathway, which was also uploaded in a medical mobile app (The Hub®). We displayed point-of-care reminders, including laminated pathway cards in the PED nursing stations. Key drivers for effective pain management in the ED were identified, including a continuous reassessment of pain as well as an effective standardized pharmacological and non-pharmacological care. Institutional Board Review (IRB) approval was obtained. We recruited nursing champions to help sustain our results. Will measure the average time from triage to IV opioid dosage, to ensure IN fentanyl as drug of choice will not delay subsequent IV opioid dosage administration. PED nursing staff trained to administer IN Fentanyl to patients with a nasal mucosa atomizer, available in the Omnicell. Exclusion criteria of patients with Sickle cell disease with other ICD-10 diagnosis codes, such as acute chest syndrome, or another type of etiology for 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 (ED/admissions). All data were collected by discrete time stamps. The database was provided by Jackson Memorial Hospital Informatics and Technology (IT) team. Data were statistically analyzed using Microsoft Office Excel 365/Prism-8. The analysis compared baseline with the first PDSA cycle from December 2019 to February 2020. Results: From December 2019 to February 2020, a total of 65 VOC encounters were analyzed. Baseline data average check-in to first dose time was 90.3 minutes, following intervention average time lowered to 70.3 minutes, which corresponds to a 24.6% decrease (Figure 2). Patients ages 15-19 represented the majority of the participants (37.9%). Male-to-female ratio was 51.5% and 48.5%, respectively. Afro-American non-Hispanic participants represented 91.2% of the study and Hispanic 8.8%. Discussion: PED staff surveys demonstrated a lack of familiarity with current VOC guidelines and the lack of a standardized pathway. Nursing surveys reported hesitancy to opioid re-administration from subjective pain assessment and opioid pain management misconception before education. PED staff shift changes, monthly new rotating residents, and the unpredictable nature of PED workflow are factors that can affect consistent VOC management. Implementing a clinical pathway available to the staff and integrating it into the workflow reduces the variability in the management of VOC visits. Hence, through teamwork, continuous pathway reinforcement, and education our outcome was associated with improvement in average time from check-in to first-dose. Conclusion: Standardized procedures to treat and reassess pain for sickle cell disease VOC patients in the PED resulted in check-in to first-dose time reduction by 24.6%. Further steps to sustain our results include guideline reinforcement and interventions with effective pharmacological i.e. intranasal fentanyl and non-pharmacological care. Figure 1 Disclosures No relevant conflicts of interest to declare.

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