A Guideline for the Nation: Managing Acute Pain

Jacox, Ada; Ferrell, Betty; Heidrich, George; Hester, Nancy Olson; Miaskowski, Christine

doi:10.1097/00000446-199205000-00019

Cited by 9 publications

(13 citation statements)

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“…At Time II, 64.2% of patients rated their pain as moderate or severe most of the time (five or higher on a 10-point scale [Serlin, Mendoza, Nakamura, Edwards, & Cleeland, 1995]). This is very comparable to the prevalence of postoperative pain reported by other researchers ( Jacox et al, 1992;Jurf & Nirschl, 1993). The lack of change in self-reported pain from Time I to Time II is probably related to several factors.…”

Section: Discussionsupporting

confidence: 90%

“…The Acute Pain Management Guideline Panel sponsored by the Agency for Health Care Policy and Research (AHCPR) concluded that reliance on "as needed" intramuscular injections of opioids for postoperative pain management and the undertreatment of postoperative pain are common phenomena (Acute Pain Management, 1992a). In surveys of surgical patients, it has been found that approximately half of all hospitalized postoperative patients failed to receive adequate pain relief ( Jacox, Ferrell, Heidrich, Hester, & Miaskowski, 1992;Jurf & Nirschl, 1993). Patients reporting moderate to high levels of pain received less than half of the pain medication that was ordered (Kitson, 1994;Tittle & McMillan, 1994).…”

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confidence: 99%

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AHCPR clinical practice guideline on surgical pain management: Adoption and outcomes

et al. 1999

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Pain management practices and short-term patient outcomes in nine acute care hospitals in Milwaukee, Wisconsin, were studied at two points in time. One-and-a-half years after the Agency for Health Care Policy and Research's (AHCPR) Clinical Practice Guideline on Acute Pain Management was published, data from 330 adult surgical patients were collected (Time I). These data were contrasted with data from 373 adult surgical patients collected 2 years later (Time II). There were significant increases in the percentage of patients who reported being taught how to report pain using a pain rating scale and about setting a pain goal preoperatively; in the percentage of patient hospital records with at least one documented numeric pain rating; and in the percentage of patients who received analgesics by intravenous administration. However, pain management practices continued to differ from recommendations in the AHCPR guideline. No significant improvement was noted in the short-term outcomes of patient-rated pain or patient satisfaction with pain management. Availability of well-published guidelines alone may be insufficient to ensure comprehensive adoption of guidelines that are multidimensional in nature and to obtain improvements in patient outcome.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

AHCPR clinical practice guideline on surgical pain management: Adoption and outcomes

et al. 1999

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“…The meperidine-equivalent doses used for the first 24 hours postoperatively in this study were only 6.30% of the recommended maximum dose of 600 mg by the American Pain Society 1 for use of meperidine-equivalent for pain management in the first 24 hours postoperatively. 14 This study shows that meperidine is the most commonly prescribed postoperative analgesic in Taiwan, although it has not been recommended for pain management by pain experts 1 ; therefore, educational efforts are needed to reduce the use of meperidine for pain management in Taiwan. The American Pain Society 1 recommends that meperidine should not be used for more than 48 hours for acute pain for patients without renal or CNS diseases, or at doses greater than 600 mg/24 hours in a patient who is an appropriate candidate to receive the drug.…”

Section: Discussionmentioning

confidence: 89%

Concerns About Reporting Pain and Using Analgesics Among Taiwanese Postoperative Patients

Tzeng

Chou

2006

The Journal of Pain

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“…As a result of the under treatment of pain and the variability of treatments, the Agency for Health Care Policy and Research (AHCPR, 1992) developed the first comprehensive clinical practice guidelines for acute pain management (Jacox, Ferrell, Heidrich, Hester & Miaskowski, 1992). In late 2000, Congress passed into law a provision declaring the tenyear period that began January 2001, as the Decade of Pain Control and Research (Hamdy, 2001).…”

Section: Historical Perspectivementioning

confidence: 99%

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings¹

2013

Journal of Pediatric Health Care

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Rationale for the Study: Despite the exponential growth in pharmacological and nonpharmacological methods for the treatment of pediatric procedural pain there remains a gap between available interventions and actual practice in the emergency department clinical setting. Researchers have recommended the examination of unit culture since culture is proposed to be a major factor that affects the implementation of pain management practices. Method:Ethnography was employed to gain access to the beliefs and practices of healthcare participants in a Northeastern non-pediatric emergency department. Data were collected for 5 months with over 100 hours of observation. Six key informants were interviewed and 44 pediatric procedural interactions with 27 healthcare providers during the treatment of children two to eight years of age undergoing procedures were observed.Other information gathered included documents from the institution, and pain related information from the patient's medical record. All interviews were recorded and transcribed verbatim. Data were managed using the Ethnograph 6.0 and analyzed using the procedure developed by Leininger and McFarland (2006). Results:Seven major themes with categories were discovered that included assessment, ii procedural pain, treatment of pain, communication related to comfort, fragmentation of care in the emergency department, healthcare provider attitudes, and environmental issues and policies. Conclusion:The results of this study suggest that practice environment of the emergency department and organizational culture exerted a significant degree of influence over healthcare providers' pediatric pain management practices. Nurses' did not use pain measurement tools as they were intended to be used and instead improvised measurement by observing the child's behavior. The management of children during painful procedures consisted of an array of behaviors and practices. The use of physical restraint during painful procedures was a common practice. Participants continue to hold many assumptions and misconceptions about pediatric pain assessment and management. The findings of this study provide insight to the everyday practice of emergency department healthcare providers for pediatric pain in a non-pediatric setting.iii Acknowledgments and Dedication

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A Guideline for the Nation: Managing Acute Pain

Cited by 9 publications

References 0 publications

AHCPR clinical practice guideline on surgical pain management: Adoption and outcomes

AHCPR clinical practice guideline on surgical pain management: Adoption and outcomes

Concerns About Reporting Pain and Using Analgesics Among Taiwanese Postoperative Patients

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

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