Increased analgesia administration in emergency medicine after implementation of revised guidelines

Abstract

BackgroundThe most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management.MethodsWe conducted a prospective pre-post intervention cohort study with implementation of a revised guideline for pain management at our ED, in which nurses are allowed to administer analgesia (including low-dosage piritramid (opioid) intravenous) without doctor intervention. Numeric Rating Scales (NRS) were measured, and administration of medication (main outcome) was documented. We included every adult patient presenting with pain (NRS 4–10) at the ED.ResultsA total of 2107 patients (1089 pre-implementation phase and 1018 post-implementation phase) were included in our study. During pre-implementation, 25.4 % of the patients with NRS between 4 and 10 received analgesia. After implementation, 32.0 % of these patients received analgesia (p < 0.001).ConclusionsAfter implementation of the revised guidelines in pain management at the ED, the administration of pain medication increased significantly. Nevertheless, the percentage of patients in pain receiving analgesia remain low (32 % after implementation).

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

“…For what concerns the intensity of pain at admission, in our sample we can see a high number of cases with severe pain, 240 cases equal to 76.9%, of which 72 (23.1%) with NRS score equal to 10, a score being higher than that found in similar studies. 13 Despite the high number of patients with severe pain at admission, for what concerns the administered therapy, we can notice, however, that morphine was rarely used, being administered to only 8 patients (2.6%). The fact that opioids are rarely used for pain management in the EDs is well known and well documented.…”

Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

“…In short, we cannot conclude 6 that regional anaesthesia may result in less complications than general anaesthesia [34]. In patients with established ARDS admitted to the ICU who require emergency surgery, the same sedative drugs used for sedation in the ICU can be maintained as well as mechanical ventilation strategies, increasing the dose of narcotics and analgesics during the surgical procedure [38].…”

Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

“…In short, we cannot conclude that regional anaesthesia may result in less complications than general anaesthesia [34]. In patients with established ARDS admitted to the ICU who require emergency surgery, the same sedative drugs 6 used for sedation in the ICU can be maintained as well as mechanical ventilation strategies, increasing the dose of narcotics and analgesics during the surgical procedure [38].…”