Effective strategy for improving instructions for analgesic use in the emergency department

Abstract

Pain is a common presenting complaint of emergency department patients. Providing instructions that can be easily recalled by patients is an important step in enabling patients to manage their pain following discharge. The effect of the introduction of written discharge instructions for pain medication on patients' recall of instructions was evaluated in this study. A patient-control study within a prospective follow-up study was performed. In the first phase, no written discharge instructions were available. Patients discharged on analgesics filled in a digital questionnaire regarding correct analgesics use. In the second phase, patients were discharged with additional written instructions and completed the same questionnaire. In the first phase, 40% of patients correctly recalled instructions for taking analgesics. In the second phase, significantly more patients, 71% (P<0.01), were able to recall the instructions correctly. Results of this study support the hypothesis that it makes sense to provide patients with written instructions about the appropriate use of analgesics, and that emergency departments that are not yet doing this should consider introducing this policy. It is a relatively low-cost measure that could lead to a significant improvement in quality of care.

Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis

“…annemergmed.com). 5,25,26,33,34 Nonetheless, several studies showed a wide range of incorrect recall in at least one domain, varying from 23% to 92%. 6,27,29,32,37,39 Four studies specifically investigated elderly patients.…”

“…Multiple studies have shown deficits in comprehension of discharge instruction. [4][5][6] For example, Engel et al 6 showed that a mere 13% of patients understood each of the 4 major domains of discharge instructions (diagnosis and cause, care given in the ED, care after the ED visit, and instructions on when to return to the ED). 6 Various studies have investigated patient education with a range of communication tools, and their results suggest that type of communication may influence correct recall of patients.…”

The Contribution of the Emergency Department To Opioid Pain Reliever Misuse And Diversion: A Critical Review

“…An important intervention that continues to hold the promise of reducing OPR misuse and diversion is targeted patient education about the appropriate and safe use of OPRs. Prior research has demonstrated that patients are more likely to understand how to correctly take their medications if provided with written instructions in addition to verbal explanation prior to discharge, with individually tailored instructions recommended as a particularly effective strategy . Further, a recent randomized control trial by McCarthy et al involving 210 patients (median age 43 years) at an urban academic ED demonstrated that implementing a targeted educational intervention to patients discharged from the ED with OPRs improved patients’ understanding of their medication's side effects and resulted in fewer reports of driving within 6 h of taking the medication.…”

Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation

“…4 5 Many studies have demonstrated that patients often leave the ED unprepared because of comprehension deficits in key information domains such as the diagnosis and cause, ED treatment, post-ED care and return precautions. [6][7][8][9][10] The results from a cross-sectional analysis demonstrated, for example, that three out of four patients were unable to recall important information for at least one of these domains. 6 Furthermore, patients may not recognise when they have limited understanding, 6 11 suggesting an inability to seek help when needed.…”