Facilitators and barriers in pain management for trauma patients in the chain of emergency care

Berben, Sivera; Meijs, T; Grunsven, P.M. van; Schoonhoven, Lisette; Achterberg, Theo van

doi:10.1016/j.injury.2011.01.029

Cited by 95 publications

(114 citation statements)

References 19 publications

(27 reference statements)

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“…Do not use nonsteroid anti-inflammatory drug (NSAID)-containing dressings as their effectiveness has not been shown and they are costly and may cause side effects (moderate). 12 Treat mild and moderate pain (VAS scores between 1 and 6) during dressing changes with paracetamol or NSAIDs (high), 13 but be cautious when prescribing NSAIDs for patients > 70 (WG). Moderate or severe pain (VAS scores 3-10) should be treated with opioids, such as morphine or fentanyl (high).…”

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confidence: 99%

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Evidence-Based Care of Acute Wounds: A Perspective

Ubbink

Brölmann

et al. 2015

Advances in Wound Care

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Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care. Critical Issues: The guidelines contain 38 recommendations, based on best available evidence, additional expert considerations, and patient experiences. In summary, primarily closed wounds need no cleansing; acute open wounds are best cleansed with lukewarm (drinkable) water; apply the WHO pain ladder to choose analgesics against continuous wound pain; use lidocaine or prilocaine infiltration anesthesia for wound manipulations or closure; primarily closed wounds may not require coverage with a dressing; use simple dressings for open wounds; and give your patient clear instructions about how to handle the wound. Future Directions: These evidence-based guidelines on acute wound care may help achieve a more uniform policy to treat acute wounds in all settings and an improved effectiveness and quality of wound care. SCOPE AND SIGNIFICANCEFor chronic wounds, such as venous, arterial, pressure, and diabetic foot ulcers, several (inter)national guidelines are available. 1 For wounds with an acute etiology, fewer guidelines exist. Still, an undesirable inconsistency in wound care practice is evident from the huge number of wound dressings available, the large number of caregivers involved, and the many opinions regarding optimum wound care. 2 This calls for more evidence-based and more uniform care to avoid undesired variation in care. TRANSLATIONAL RELEVANCEIn terms of translational research, available guidelines have focused on diminishing barriers for wound healing given certain comorbid conditions, 3 or have described inconsistencies in the documentation of surgical wound care according to existing guidelines, mainly regarding the prevention and treatment of surgical site infections, which hamper interdisciplinary communication. 4 CLINICAL RELEVANCECurrent clinical guidelines on acute wound care comprise the CDC

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confidence: 99%

“…Moderate or severe pain (VAS scores 3-10) should be treated with opioids, such as morphine or fentanyl (high). 13 Use the WHO pain ladder to choose a suitable analgesic to treat pain between dressing changes (WG).…”

mentioning

confidence: 99%

Evidence-Based Care of Acute Wounds: A Perspective

Ubbink

Brölmann

et al. 2015

Advances in Wound Care

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“…16 Based on the finding that the protocol change sustained the improvement in pain treatment into the maintenance phase, it appears our system changes addressed barriers that have been previously identified in the literature. 3,7,8 However, our results highlight that there are still significant numbers of patients who are not treated. In fact, 46% of patients in the maintenance phase were documented as meeting the criteria of the pain management protocol and did not receive pain treatment.…”

Section: Discussionmentioning

confidence: 67%

“…These include limited education, 7 inadequate pain assessment tools, 3 lack of pain management treatment protocols, and attitudes regarding pain management. 8 Acknowledging this deficit, professional organizations have made statements emphasizing the need for both the assessment and management of pain in the prehospital setting. In 2001, The Joint Commission and Accreditation of Healthcare Organizations (JCAHO) highlighted pain management as a standard of care for patients while in the hospital.…”

Section: Introductionmentioning

confidence: 99%

Effect of System-Wide Interventions on the Assessment and Treatment of Pain by Emergency Medical Services Providers

Haley¹,

Lerner²,

Guse³

et al. 2016

Prehospital Emergency Care

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“…Our study showed that most patients in the ED were there as a result of trauma. Trauma patients admitted to the emergency department are a group requiring special treatment because of the high probability of loss of life and health [1,5,6]. Based on research conducted by Karavan [7] the injured patients are usually young people.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of pain and stress in emergency department patients

Krzyszycha

Goniewicz

et al. 2016

Polish Journal of Public Health

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Introduction. In Poland, among patients coming to hospital emergency departments (ED), one third require immediate surgical treatment. About one third are transferred to long-term intensive care. The remaining patients require a different type of care, e.g. consultation, healing wounds, observation in the emergency department. From there, they might either be referred to another hospital department or sent home after receiving outpatient help.Aim. The aim of this study was to determine the prevalence of pain and stress in patients treated in the emergency department with particular emphasis on the factors that determine their level.Material and methods. The study group consisted of 200 individuals treated in the emergency department of the Regional Hospital No. 2 in Rzeszów in 2013. The applied research method was a diagnostic survey that used a questionnaire as a research tool. The results were statistically analyzed using SPSS 20, whereas a statistically significant dependence was considered in those with level of significance p≤0.05.Results. Most respondents reported pain and feelings of stress while staying in the ED. Women and the unemployed were significantly less likely to report pain. Factors like gender, age, education level, and the coexistence of chronic diseases significantly affected the degree of stress among patients in the ED.Conclusion. Each patient treated at the emergency department should receive holistic care, so that the pain and stress of his injuries are reduced as soon as possible.

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Facilitators and barriers in pain management for trauma patients in the chain of emergency care

Cited by 95 publications

References 19 publications

Evidence-Based Care of Acute Wounds: A Perspective

Evidence-Based Care of Acute Wounds: A Perspective

Effect of System-Wide Interventions on the Assessment and Treatment of Pain by Emergency Medical Services Providers

Meta-analysis of pain and stress in emergency department patients

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