Intervention Study with Algoplus^®: A Pain Behavioral Scale for Older Patients in the Emergency Department

Abstract

The systematic introduction of Algoplus scale in the ED allowed a change in practice by improving evaluation and management of pain in patients ≥ 75 years old, especially when difficult to be evaluated. Algoplus allowed an objective levelling of analgesics prescription in all admitted patients. It also promoted field action to improve pain management in ED.

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

“…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 …”

“…Risk of bias assessment was performed for 4 RCTs and 33 nonrandomised studies (). Out of the 31 articles in which opioid use was evaluated as a primary outcome, 24 studies were graded as having either a moderate or serious risk of bias, largely due to confounding or selection of participants into the study . A moderate or serious risk of bias was found in 3 of 6 studies in which opioid use was addressed as a secondary outcome .…”

“…Five studies used tools to guide the appropriate prescribing of opioids . A pain assessment tool was used in 1 study, which did not report a significant difference in the quantity of opioids used …”

“…Out of the 31 articles in which opioid use was evaluated as a primary outcome, 24 studies were graded as having either a moderate or serious risk of bias, largely due to confounding or selection of participants into the study. [21][22][23][24][26][27][28][30][31][32][35][36][37][39][40][41][42][43][44]50,52,[54][55][56] A moderate or serious risk of bias was found in 3 of 6 studies in which opioid use was addressed as a secondary outcome. 33,34,48 Selective reporting of outcomes and other risk of bias were unclear in most studies.…”

“…Thirty-one studies examined the effect of interventions to improve prescribing or clinical outcomes related to opioid use. Interventions used to improve appropriate opioid use for analgesia included 16 articles which employed a multifaceted intervention to educate health providers (such as prescribers, nurses, pharmacists) and patients to change opioid use, [20][21][22][23][24][25][26][27][28][29][30]35,38,[50][51][52] 5 studies using decision-making tools to guide opioid prescribing [39][40][41][42]56 and 10 that targeted pain monitoring and response to analgesic treatment. 31,32,36,37,[43][44][45][53][54][55] Predominant prescribing outcomes included the quantity of opioids prescribed and compliance to published guidelines, while clinical outcomes included pain intensity, opioid-related ADEs and patient satisfaction with adequate pain control.…”