Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain

Abstract

IntroductionPain is a common symptom presented in the emergency department (ED) although it is often underestimated, poorly evaluated and treated. The application of a protocol for timely pain management ensured by the nurse can avoid the delays in the analgesic treatment and improve the patient’s quality of waiting.AimsTo check the effectiveness and efficiency of the protocol aimed at early pain management in triage, active in our ED. In particular, the response to analgesic treatment was evaluated 60 minutes after the administration and at discharge. Patient satisfaction was also evaluated using two anonymous questionnaires both at discharge and 48 hours later via telephone.MethodsA single-center, observational study was conducted on a prospective cohort of patients (aged ≥4 years) with a pain symptom at admission in ED with no surgical picture.ResultsIn the observation period (June 2015–May 2016), 382 patients were enrolled, and of these, 312 (84.8%) accepted pain therapy during triage stage in the ED. In 97.4% of the cases, orosoluble paracetamol 1000 mg was administered. In the re-evaluation done 60 minutes later, 65.9% of the patients showed a reduction of at least 2 points on Numeric Rating Scale (NRS), equal to a mean reduction of 2.24 points (95% CI: 2.03–2.45). The mean time of analgesia intake was equal to 5.9 minutes (95% CI: 3.8–8.1). In the re-evaluation done at discharge, 33.2% of the patients showed a reduction of NRS score >50%, leading to a mean reduction of 39% (95% CI: 35.3%−41.9%). The level of patient satisfaction was high with a mean value >9 points (maximum satisfaction =10).ConclusionThis protocol shows that optimal pain management was achieved by patients rapidly receiving an effective painkiller therapy at triage, leading to substantial patient satisfaction. In moderate pain, orosoluble paracetamol 1000 mg provided a reduction of NRS score by 2 points in 67.6% of the patients, confirming to be the analgesic of choice in ED.

Pain in emergency units: correlation with risk classification categories

“…The search for emergency services is motivated by painful complaints which can be perceived in different ways. Thus, nurses must be aware of the time of their evaluation to provide the best care 6 .…”

“…Pain is defined by the American Pain Society as the fifth vital sign, and should be assessed along with temperature, respiratory rate, pulse and blood pressure. Its evaluation helps to diagnose the problem presented by the patients 6 . Nurses should investigate pain and use of instruments to assist in its measurement, as well as in the response to analgesia.…”

The Effectiveness of Near-Field Communication Integrated with a Mobile Electronic Medical Record System: Emergency Department Simulation Study

“…Ideal physical structures for work have already been demonstrated [ 19 ]. Several studies have shown the positive effect of developing clinical guidelines and protocols for effective evaluation of efficiency [ 20 , 21 ]. Newer technologies such as radio frequency identification-integrated point-of-care testing [ 22 ], triage kiosks [ 23 ], and dashboards [ 24 ] have been well studied.…”

Effectiveness of Near-field Communication Integrated with Mobile Electronic Medical Record System in Terms of Physician Turn-around Time in an Emergency Department: Simulation Study (Preprint)

“…In terms of physical structures, ideal structures for work have been demonstrated [17]. Several studies have shown the positive effect on efficiency of developing clinical guidelines and protocols for effective evaluation [18,19]. Newer technologies such as radio frequency identification (RFID)-integrated point-of-care testing (POCT) [20], triage kiosks [21], and dashboards [22] have been well studied.…”