Nurse-initiated oral opioid pain protocol improves the quality of musculoskeletal pain management in the emergency department

Caspi, Sigalit; Meidan, Ronit; Peless, Elad; Raizman, Ela

doi:10.1016/j.ienj.2018.07.003

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…This study showed that the nurse-initiated PP for severe pain due to various pain etiologies is feasible in a busy pediatric ED setting. Our results showed approximately a 10% increase in patients with severe pain who received analgesia after protocol introduction, which is consistent with the improved treatment seen in other PP studies 31–33 . Although more patients presenting with pain received analgesia, we were unable to change the selection of analgesic medication for different severities of pain 29 .…”

Section: Discussionsupporting

confidence: 87%

“…Our results showed approximately a 10% increase in patients with severe pain who received analgesia after protocol introduction, which is consistent with the improved treatment seen in other PP studies. [31][32][33] Although more patients presenting with pain received analgesia, we were unable to change the selection of analgesic medication for different severities of pain. 29 Although pain was recognized and treated more frequently after the protocol introduction, nurses still overwhelmingly selected acetaminophen or ibuprofen as their first drug of choice.…”

Section: Discussionmentioning

confidence: 99%

“…Nurse-initiated PPs have been studied more extensively in adults 31,33,41,42 ; however, there are limited studies in the pediatric population, most of which are for musculoskeletal injuries, vasoocclusive crises, and postoperative pain. 28,34,43,44 This study adds to the growing knowledge of the utilization of ED PPs in the pediatric population and is one of the few looking at general presentations of severe pain due to various complaints, rather than a specific etiology.…”

Section: Discussionmentioning

confidence: 99%

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Pain Reduction Emergency Protocol

Guiner¹,

Street²,

Oke

et al. 2020

Pediatr Emer Care

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Objectives: Pain control remains suboptimal in pediatric emergency departments (EDs). Only 60% of pediatric patients requiring pain medications receive them in the ED, with an average time of administration being 90 minutes after arrival. Although pain protocols (PP) have been proposed and evaluated in children with long-bone fractures, data on PP utility for general pediatric patients with acute pain are limited. Our objective is to introduce a nursing-initiated PP with medication algorithms for use in triage, measure the improvement in management of severe pain on arrival to the ED and determine the effect on parental satisfaction.Methods: Prospective prestudy and poststudy conducted from June to October 2017. Patients aged 3 to 17 years presenting to a large tertiary pediatric ED with acute pain were eligible. Preprotocol demographics, clinical data, and pain interventions were obtained over a 6-week period. A convenience sample of parents completed a satisfaction survey rating their experience with ED pain management during this time. In the 4-week intervention phase, the PP was introduced to our ED nurses. Postintervention data were collected in the same fashion as the preintervention phase. Analysis was done using independent sample t test and χ 2 models.Results: There were 1590 patients evaluated: preprotocol (n = 816), postprotocol (n = 774). Approximately 10% more patients with severe pain received pain medication in the post-PP sample compared with pre-PP (85.6% and 75.9% respectively). Parental satisfaction was higher in patients who received analgesic medications within 90 minutes of arrival to the ED (P = 0.007). Conclusions:The introduction of a PP in the ED setting improved the treatment of pain. There was a significant increase in patients with severe pain receiving analgesic medications. Additionally, parents were more satisfied if their children received pain medication in a more timely fashion. Pediatric EDs should consider introducing PPs to improve appropriate and timely administration of pain medication in triage.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pain Reduction Emergency Protocol

Guiner¹,

Street²,

Oke

et al. 2020

Pediatr Emer Care

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“…The need for venous access and a nurse exclusively dedicated to titration (high level of resources) could be organizational barriers, leading to therapeutic alternatives, more available, resulting in a morphine-saving strategy, especially in case of ED crowding. Other routes of administration could be interesting alternatives [ 51 , 52 , 53 ], still, so far, underprescription of IV morphine protocols has been poorly investigated regarding routine organizational constraints in the ED (e.g., logistics and nurse availability). Moreover, the state of knowledge in the field of opioid management has changed considerably since 2010.…”

Section: Introductionmentioning

confidence: 99%

Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices

Lvovschi

Hermann

Lapostolle

et al. 2021

JCM

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Intravenous (IV) morphine protocols based on patient-reported scores, immediately at triage, are recommended for severe pain in Emergency Departments. However, a low follow-up is observed. Scarce data are available regarding bedside organization and pain etiologies to explain this phenomenon. The objective was the real-time observation of motivations and operational barriers leading to morphine avoidance. In a single French hospital, 164 adults with severe pain at triage were included in a cross-sectional study of the prevalence of IV morphine titration; caregivers were interviewed by real-time questionnaires on “real” reasons for protocol avoidance or failure. IV morphine prevalence was 6.1%, prescription avoidance was mainly linked to “Pain reassessment” (61.0%) and/or “alternative treatment prioritization” (49.3%). To further evaluate the organizational impact on prescription decisions, a parallel assessment of “simulated” prescription conditions was simultaneously performed for 98/164 patients; there were 18 titration decisions (18.3%). Treatment prioritization was a decision driver in the same proportion, while non-eligibility for morphine was more frequently cited (40.6% p = 0.001), with higher concerns about pain etiologies. Anticipation of organizational constraints cannot be excluded. In conclusion, IV morphine prescription is rarely based on first pain scores. Triage assessment is used for screening by bedside physicians, who prefer targeted practices to automatic protocols.

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Opioid Reflex at Triage Is Not a Solution for Opioid-Naive Patients in Emergency Departments

Lvovschi

Deroanne

Camargo

2020

Annals of Emergency Medicine

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Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.1. Schenkel SM, Wyer PC. Evaluating clinical decision tools: can we optimize use before they turn us into fools?

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Nurse-initiated oral opioid pain protocol improves the quality of musculoskeletal pain management in the emergency department

Cited by 4 publications

References 28 publications

Pain Reduction Emergency Protocol

Pain Reduction Emergency Protocol

Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices

Opioid Reflex at Triage Is Not a Solution for Opioid-Naive Patients in Emergency Departments

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