Improving early acute pain management in an academic tertiary centre emergency department st. michael's hospital


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Improving early acute pain management in an academic tertiary centre emergency department st. michael's hospital

  1. 1. Improving Early Acute Pain Management in an Academic Tertiary Centre Emergency Department K Nixon1, 2 G Martin1 M McGowan1 D MacKinnon1, 2 Gaunt1 G Bandiera1 L Barratt1 E Nagatu1 N Ahmed2 M Bawazeer2 and J Spence1 on behalf of the St. Michael’s Hospital Department of Emergency Medicine1 and Trauma Program2 K
  2. 2. Early Acute Pain Management in the ED Context • Significant number of patients come to the Emergency Department with acute pain; however, assessing and treating acute pain may not always be as timely as staff and patients wish with competing clinical priorities and limitations of space and volume Problem and Issue • Best practices suggest that pain management for the emergency and trauma patient should be a priority in order to prevent complications of acute pain and maintain the validity of clinical assessment findings; however, under-treatment of acute pain (oligoanalgesia) is well documented and is a common source for patient dissatisfaction • Pain is a dimension of patient satisfaction that is measured with the validated NRC Picker; however, caution must be heeded with interpretation - low response rate, patient recall and precludes those with mental illness, homeless/sheltered and admitted to hospital
  3. 3. Early Acute Pain Management in the ED Measurement Pain Management Beliefs. 45-question survey on knowledge of pain management  Patient is most accurate judge of intensity of pain communicated reliably with a 10-point scale (MD 74%, RN 67%)  Pain management is of equal priority with other aspects of clinical care (RN 85%, MD 77%); however staff estimated only 51-75% achieved pain relief satisfaction (RN 46%, MD 38%)  Additional barriers to effective pain management were clinical volume, work load and waiting for diagnostics or adequate treatment space Patient Report. 10-question survey insitu. 54% perceived minimal delay until Emergency staff (MD 43%, RN 31%, both 8%) discussed pain relief, with medication options being most prominent (80%); perception of adequate pain relief (yes 42%, no 31%) was mixed though most (79%) felt staff were doing everything they could Figure 1. Reason for Inadequate Pain Management
  4. 4. Early Acute Pain Management in the ED Contribution to Patient Safety & Quality Improvement • Quality patient care includes providing early and effective pain management • A best-practices informed standardized medication order set was implemented and facilitates safe prescribing and timely administration of opioids for acute pain in the Emergency Department. • A collaborative approach, engaging the expertise and champions from the Acute Pain Service, Pharmacy, Nursing Professional Practice, Quality & Risk Management, Emergency Nursing, General Surgery and the Emergency and Trauma management and physician groups has led to enhanced monitoring of process, quality indices and engagement with the patient experience