Best‐practice pain management in the emergency department: A cluster‐randomised, controlled, intervention trial

Taylor, David; Fatovich, Daniel M; Finucci, Daniel; Furyk, Jeremy; Jin, S X; Keijzers, Gerben; MacDonald, Setphen P J; Mitenko, Hugh; Richardson, Jeff; Ting, Joseph; Thom, Ogilvie; Ugoni, Antony; Hughes, James Alexander; Bost, Nerolie; Ward, Meagan; Gibbs, Clinton; MacDonald, Ellen; Chalkley, Dane

doi:10.1111/1742-6723.12498

Cited by 31 publications

(54 citation statements)

References 28 publications

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“…Although the extent and degree of this problem has recently been challenged,2 it is likely that considerable scope remains for improvement in ED pain management practice. Initiatives to improve pain management have included staff training,3 mandatory recording of pain scores,4 nurse-initiated analgesia (NIA, prescribed and administered by a nurse),5 time-to-analgesia performance indicators6 and the provision of ‘adequate analgesia’ as measured by changes in the pain score 7 8. The overall aim of these initiatives is to provide early, safe and effective analgesia to those with valid indications.…”

Section: Introductionmentioning

confidence: 99%

Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department

et al. 2016

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Objective To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). Methods We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint. The study sample was randomly selected from a list of all eligible patients. Data were extracted electronically from the ED records and by explicit extraction from the medical record. Logistic regression models were constructed to assess associations with the three binary study end points. Results 1289 patients were enrolled. Patients were less likely to receive any analgesia if they presented 08:00-15:59 hours (OR 0.67, 95% CI 0.46 to 0.98) or 16:00-24:00 hours (OR 0.55, 95% CI 0.37 to 0.80) were triage category 5 (OR 0.20, 95% CI 0.08 to 0.49) or required an interpreter (OR 0.34, 95% CI 0.14 to 0.86). Patients were less likely to receive NIA or early analgesia if they were aged 56 years or more (OR 0.70 and 0.63; OR 0.57 and 0.21, respectively) or if they had received ambulance analgesia (OR 0.59, 95% CI 0.36 to 0.95; OR 0.38, 95% CI 0.20 to 0.74, respectively). Conclusions Patients who present during the daytime, have a triage category of 5 or require an interpreter are less likely to receive analgesia. Older patients and those who received ambulance analgesia are less likely to receive NIA or early analgesia.

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Section: Introductionmentioning

confidence: 99%

Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department

et al. 2016

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“…Fifteen interventions involved surgical inpatients, 3 were implemented in the intensive care unit, 7 were conducted in the ED, 5 involved geriatric inpatients (≥65 years), and the remaining 7 studies were conducted in all inpatients, and those receiving patient‐controlled analgesia (PCA) or transdermal fentanyl …”

Section: Resultsmentioning

confidence: 99%

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Liu

Gnjidic

Nguyen

et al. 2020

Brit J Clinical Pharma

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Aims To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients. Methods Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947). Results Of 398 full‐text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty‐one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard‐copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient‐controlled analgesia reduced medication errors by up to 89.1%. Conclusion Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.

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“…This technique has been used previously in order to avoid the Hawthorne effect impacting upon the outcome measures 13. Hence, both patients and ED staff were blinded to enrolment and the provision of pain advice to the intervention group.…”

Section: Methodsmentioning

confidence: 99%

“…Given this, the study was not powered to demonstrate a statistically significant change in patient satisfaction. However, a recent multicentre clinical trial13 indicated that approximately 80% of patients recall being provided with pain advice as part of standard care. We expected that at least 90% of patients in the intervention arm of this pilot would recall having received pain advice.…”

Section: Methodsmentioning

confidence: 99%

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The effect of provision of pain management advice on patient satisfaction with their pain management: a pilot, randomised, controlled trial (pain advice trial)

et al. 2016

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Objective We aimed to provide pain advice ('The treatment of pain is very important and be sure to tell the staff when you have pain') as an intervention and evaluate its effect upon patient satisfaction. The purpose of this pilot trial was to ensure the design and methods of a future trial are sound, practicable and feasible. Method We undertook a pilot, randomised, controlled, clinical intervention trial in a single ED. The control arm received standard care. The intervention arm received standard care plus pain advice from an independent investigator. All patients and treating ED staff were blinded to patient enrolment. Patient satisfaction with their pain management (six-point ordinal scale) was measured 48 h post-ED discharge, by a blinded researcher. The primary outcome was satisfaction with pain management. Results Of the 280 and 275 patients randomised to the control and intervention arms, respectively, 196 and 215 had complete data, respectively. 77.6% (152/196) and 88.8% (191/215) of patients reported being provided with pain advice, respectively (difference 11.3% (95% CI 3.6 to 19.0)). The intervention was associated with absolute and relative increases in patient satisfaction of 6.3% and 14.2%, respectively. 91.3% (179/196) and 76.3% (164/215) of patients who were/ were not very satisfied reported having received 'pain advice' (difference 15.0% (95% CI 7.6 to 22.5)). Conclusions The intervention to provide pain advice resulted in a non-significant increase in patient satisfaction. A larger multicentre trial is feasible and is recommended to further explore the effects of provision of pain advice. Trial registration number ACTRN12615000097549.

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Best‐practice pain management in the emergency department: A cluster‐randomised, controlled, intervention trial

Abstract: The 'adequate analgesia' intervention significantly improved patient satisfaction. It provides a simple and efficient target in the pursuit of best-practice ED pain management.

Cited by 31 publications

References 28 publications

Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department

Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

The effect of provision of pain management advice on patient satisfaction with their pain management: a pilot, randomised, controlled trial (pain advice trial)

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