Quality improvement activity for improving pain management in acute extremity injuries in the emergency department

Chang, Hyung Lan; Jung, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Lee, Jin Hee; Jung, Jae Yun; Kwon, Hyuksool; Paek, So Hyun; Park, Joong Wan; Shin, Jonghwan

doi:10.15441/ceem.17.260

Cited by 3 publications

(4 citation statements)

References 20 publications

(24 reference statements)

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“…Pain score assessment at triage has been shown to decrease the time to prescription of the first analgesic in previous studies. 14 15 Additionally, nurse-initiated analgesia at triage has been associated with reduced analgesia administration time. 17 19 20 However, this optimal change idea was not feasible in our context due to the absence of triage nurses capable of administering analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in this study, focusing on the time to analgesia ‘administration’ rather than ‘prescription’ provided a more clinically relevant outcome measure, as it reflects the actual time it takes for patients to receive pain medication. 15 The incorporation of educational training programmes and creation of posters served as effective strategies in this study. These initiatives enhanced the knowledge and skills of the healthcare staff and also provided visual reminders, reinforcing adherence to standardised pain management practices.…”

Section: Discussionmentioning

confidence: 99%

“… 5 16 Quality improvement (QI) initiatives in various countries have demonstrated positive outcomes in reducing analgesia administration times, but a literature gap exists in addressing this issue specifically in India. 15 17 Hence, we embarked on this QI project, aiming to provide valuable insights that can inform and improve pain management practices in our setting.…”

Section: Introductionmentioning

confidence: 99%

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Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Sadasivam S,

Kumaran,

Manu Ayyan

et al. 2024

BMJ Open Qual

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IntroductionPain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many EDs face challenges in pain management and present opportunities for improvement. This initiative aimed to expedite the administration of the first analgesic in patients with musculoskeletal pain in the ED.Local problemObservations within our ED revealed that patients with musculoskeletal injuries triaged to yellow or green areas experienced prolonged waiting times, leading to delayed analgesic administration, thereby adversely affecting clinical care and patient satisfaction.Specific aimThe aim of our quality improvement (QI) project was to reduce the time to administration of first analgesia by 30% from baseline, in patients with musculoskeletal injuries presenting to our academic ED, in a period of 8 weeks after the baseline phase.MethodsA multidisciplinary QI team systematically applied Point-of-Care Quality Improvement and Plan-Do-Study-Act (PDSA) cycle methodologies. Process mapping and fishbone analyses identified the challenges in analgesia administration. Targeted interventions were iteratively refined through PDSA cycles.InterventionsInterventions such as pain score documentation at triage, fast-tracking of patients with moderate-to-severe pain, resident awareness sessions, a pain management protocol and prescription audits were executed during the PDSA cycles. Successful elements were reinforced and adjustments were made to address the identified challenges.ResultsThe median door-to-analgesia timing during the baseline phase was 55.5 min (IQR, 25.75–108 min). During the postintervention phase, the median was significantly reduced to 15 min (IQR, 5–37 min), exceeding the anticipated outcomes and indicating a substantial 73% reduction (p value <0.001) from baseline.ConclusionImplementing simple change ideas resulted in a substantial improvement in door-to-analgesia timing within the ED. These findings significantly contribute to ongoing discussions on the optimisation of pain management in emergency care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Sadasivam S,

Kumaran,

Manu Ayyan

et al. 2024

BMJ Open Qual

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“…When associated with waiting for care, experience in EDs may become unbearable, which may exacerbate patients' clinical status (5)(6)(7) . As such, pain management is an essential component of quality care delivery in EDs (8)(9) .…”

Section: Introductionmentioning

confidence: 99%

Assessment of the implementation of a nurse-initiated pain management protocol in the emergency department

et al. 2021

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Objectives: to assess the implementation of a nurse-initiated pain management protocol for patients triaged as semi-urgent, and its impact in pain intensity, in the Emergency Department. Methods: a prospective cohort study for adult patients with pain who had been triaged as semi-urgent and admitted to the hospital’s Emergency Department. Patients who received the intervention (pain-management protocol with analgesic administration) were compared to those who were managed using the conventional approach (physician evaluation prior to analgesic administration). Results: of the 185 patients included, 55 (30%) received the intervention, and 130 (70%) were managed conventionally. Patients in the intervention group were more likely to have taken pain medication in the 4 hours prior to admission, and reported higher levels of pain at admission and more significant reductions in pain level. Conclusions: despite low protocol adherence, the intervention resulted in higher reported pain relief.

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Acil servise başvuran açık el yaralanmalı hastaların araştırılması

Yalçin

Bedel

Tomruk

et al. 2018

Journal of Health Sciences and Medicine

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Giriş: El yaralanmaları ülkemizde sıklıkla görülen, ciddi iş gücü ve fonksiyon kaybına yol açan bir durumdur. Türkiye'de el yaralanmalarının oluş nedenleri ve epidemiyolojisi ile ilgili çalışmalar sınırlıdır. Biz bu çalışmada acil servisimize açık el yaralanması ile başvuran hastaların etiyolojilerini, demografik özelliklerini, klinik bulgularını ve sonuçlarını ortaya koyarak ileride uygulanması muhtemel bir önleyici program için ışık tutacak verilerin elde edilmesini amaçladık. Gereç ve Yöntem: Ocak 2010-Aralık 2013 tarihleri arasında acil servise izole açık el yaralanması nedeniyle başvuran 1180 hastanın kayıtları retrospektif olarak incelendi. Kayıtlardan yaş, cinsiyet, başvuru günü, meslek, yaralanma nedeni, yaranın lokalizasyonu, yaranın türü, yapılan medikal tedaviler ve sonuçları incelenmiştir. Bulgular: Çalışmaya alınan hastaların 889'unu (%75,3) erkekler oluşturmuştur. Yaş ortalaması 32 (0-86)'dir. El travmalarının meydana geldiği günler incelendiğinde en fazla travmanın 185 hasta (%15,7) ile cuma gününde olduğu görülmüştür. Çalışmaya alınan hastaların 699'u (%59,2) ev kazasında yaralanmıştır. En sık yaralanan meslek grubunun 103 olgu (%8,7) ile kereste-ahşap işinde çalışanlar olduğu saptanmıştır. Çalışmaya alınan hastaların 596'sında (%50,5) yüzeyel yaralanma saptanmıştır. Olguların 488'i (%41,4) primer sütüre edilmiş ve 788'i (%66,8) de taburcu edilmiştir. Sonuç: El yaralanmasıyla acil servise başvuran hastaların büyük bir kısmını çalışan genç erkek hastalar oluşturmaktadır. El yaralanmalarının erken tedavisi ve uygun rehabilitasyonu iş gücü kayıpları ve ekonomik giderleri azaltmak için önemlidir. Burada asıl üstünde durulması gereken nokta el yaralanmalarının önüne geçebilecek önleyici tedbirlerin alınması olduğu düşünülmektedir.

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Quality improvement activity for improving pain management in acute extremity injuries in the emergency department

Cited by 3 publications

References 20 publications

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Assessment of the implementation of a nurse-initiated pain management protocol in the emergency department

Acil servise başvuran açık el yaralanmalı hastaların araştırılması

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