Simulation‐based training for pain assessment in the emergency department

Ghazali, Daniel Aiham; Kenway, Philippe; Casalino, Enrique

doi:10.1111/medu.13975

Cited by 2 publications

(6 citation statements)

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“…Overcrowding in the ED makes it difficult to re-evaluate patients and, therefore, institute additional analgesic treatments. During the COVID-19 pandemic, the creation of a fast track for lower-acuity, non-COVID-19 patients outside the ED [ 21 ] prompted us to empower these individuals in their pain assessment [ 8 ]. Furthermore, we introduced methoxyflurane self-administration as an adjunct to standard analgesic treatments for mild and moderate trauma pain [ 1 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…All the triage nurses had at least 6 months of experience and had been trained (using simulations) to (i) manage pain, (ii) explain the use of the pain self-questionnaire to the patient (in both study phases), and (iii) explain the use of the methoxyflurane inhalation device (in the second phase only) [ 8 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…The triage nurse handed out the pain assessment document in French or English ( Appendix A ). The pain assessment document comprised three sections [ 8 , 16 ]: two sections were filled out by the triage nurse, and one part was filled out by the patient during their stay in the ED. The document was used to record information on the nature of the trauma, the type of analgesics received, the time required for the onset of analgesia, the number of vials of methoxyflurane used (1 or 2), and any nonserious and serious AEs.…”

Section: Methodsmentioning

confidence: 99%

“…In the ED, pain is assessed by the triage nurse as soon as the patient arrives; in principle, the nurse can start the treatment immediately. However, pain is underreported and is not optimally managed [ 7 , 8 , 9 ]. Methoxyflurane (Penthrox ® , Medical Developments International Limited, Melbourne, Australia) is a volatile inhalation analgesic that provides rapid, short-term analgesia via a hand-held inhaler device [ 10 ] and may be an effective, non-narcotic option for emergency pain management in prehospital and ED settings [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective, Interventional, Single-Center Study

Ghazali,

Bouzid,

Frachon

et al. 2023

IJERPH

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The coronavirus disease 2019 (COVID-19) pandemic has led to overcrowding in many emergency departments (EDs). The present single-center, prospective, interventional study (conducted at Bichat University Medical Center (Paris, France)) was designed to assess the impact of self-administered, inhaled, low-dose methoxyflurane on trauma pain in a pre-ED fast-track zone dedicated to the management of lower-acuity non-COVID-19 patients. In the first phase of the study, the control group consisted of patients with mild-to-moderate trauma pain, for whom the triage nurse initiated pain management (based on the World Health Organization (WHO)’s analgesic ladder). In the second phase, the intervention group consisted of similar patients who self-administered methoxyflurane as an adjuvant to the standard analgesic ladder. The primary endpoint was the numerical pain rating scale (NPRS) score (from 0 to 10) recorded at different time points during the patient’s care (T0: arrival in the ED, T1: exit from the triage box, T2: in the radiology department, T3: clinical examination, and T4: discharge from the ED). The level of agreement between the NPRS and the WHO analgesic ladder was assessed by the calculation of Cohen’s kappa. Pairwise comparisons of continuous variables were performed with Student’s t-test or a non-parametric Mann–Whitney U test. Changes over time in the NPRS were analyzed in an analysis of variance (with Scheffe’s post hoc test if a pairwise comparison was significant) or a non-parametric Kruskal–Wallis H test. In all, 268 and 252 patients were included in the control and intervention groups, respectively. The two groups had similar characteristics. The level of agreement between the NPRS score and the analgesic ladder was high in both the control and intervention groups (Cohen’s kappa: 0.74 and 0.70, respectively). The NPRS score decreased significantly between T0 and T4 in both groups (p < 0.001), but the decrease between T2 and T4 was significantly greater in the intervention group (p < 0.001). The proportion of patients still in pain on discharge was significantly lower in the intervention group than in the control group (p = 0.001). In conclusion, a combination of self-administered methoxyflurane and the WHO analgesic ladder improves pain management in the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective, Interventional, Single-Center Study

Ghazali,

Bouzid,

Frachon

et al. 2023

IJERPH

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“…In spite of the well-known effectiveness and importance of simulation-based education prior to hands-on practice, reliable data on this topic is still sparse and simulation-based learning is still not implemented as a major teaching method in medical schools in Germany [15][16][17][18]. ,…”

Section: Introductionmentioning

confidence: 99%

Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching

et al. 2021

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Background Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested. Methods Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions. Results This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication. Conclusions Training with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.

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Simulation‐based training for pain assessment in the emergency department

Cited by 2 publications

References 1 publication

Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective, Interventional, Single-Center Study

Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective, Interventional, Single-Center Study

Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching

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