Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec;9(1):4.
doi: 10.1186/s12245-016-0102-y. Epub 2016 Feb 10.

Increased analgesia administration in emergency medicine after implementation of revised guidelines

Geesje Van Woerden  1 , Crispijn L Van Den Brand  2 , Cornelis F Den Hartog  3 , Floris J Idenburg  4 , Diana C Grootendorst  5 , M Christien Van Der Linden  6
Affiliations

Increased analgesia administration in emergency medicine after implementation of revised guidelines

Geesje Van Woerden et al. Int J Emerg Med. 2016 Dec.

Abstract

Background: The 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.

Methods: We 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.

Results: A 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).

Conclusions: After 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).

Keywords: Acute pain; Analgesics; Emergency department; Pain management.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flowchart pain management. 1Reassess after each step, and if NRS is still ≥4, follow next step in the flowchart
Fig. 2
Fig. 2
Flow diagram in pre- and post-implementation phases
See this image and copyright information in PMC

References

    1. Berben SA, Meijs TH, van Dongen RT, van Vugt AB, Vloet LC, Mintjes-de Groot JJ, et al. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department. Injury. 2008;39:578–585. doi: 10.1016/j.injury.2007.04.013. - DOI - PubMed
    1. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007;8:460–466. doi: 10.1016/j.jpain.2006.12.005. - DOI - PubMed
    1. Carter D, Sendziuk P, Eliott JA, Braunack-Mayer A. Why is pain still under-treated in the emergency department? Two new hypotheses. Bioethics. 2015. PMID:26104124 [Epub ahead of print]. doi:10.1111/bioe.12170. - PubMed
    1. Guru V, Dubinsky I. The patient vs. caregiver perception of acute pain in the emergency department. J Emerg Med. 2000;18:7–12. doi: 10.1016/S0736-4679(99)00153-5. - DOI - PubMed
    1. Decosterd I, Hugli O, Tamches E, Blanc C, Mouhsine E, Givel JC, et al. Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain. Ann Emerg Med. 2007;50:462–471. doi: 10.1016/j.annemergmed.2007.01.019. - DOI - PubMed

LinkOut - more resources