Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

Abstract

Introduction: Pain management is a critical aspect of effective long bone fracture treatment. Pediatric patients frequently report suboptimal pain management, which is an area of growing public concern. The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures ≤47 minutes of emergency department arrival. Methods: A multidisciplinary team developed a standardized protocol for pain management of patients presenting with musculoskeletal pain utilizing acetaminophen as the first-line agent under a nurse-initiated order. Following education and implementation, weekly reports generated using the International Classification of Diseases codes of fractures were reviewed to assess compliance with the protocol. This study evaluates the frequency of a second pain medication administration and reduction in vital signs and pain scores. Results: Implementation of a pain management protocol reduced median time to pain medication administration to 26 minutes. Overall, 63% (n = 638) of patients required a second pain medication. Of these, 66.5% (348/523) who initially received acetaminophen and 59.7% (286/479) who initially received an opioid required a second pain medication. No significant changes in pre and posttreatment vital signs were found between groups. Patients who initially received opioids experienced a greater reduction in posttreatment pain scores. Conclusions: Using a standardized pain management protocol in combination with comprehensive education effectively reduces median time to pain medication administration in pediatric patients with long bone fractures. Acetaminophen is a rapid and effective first-line agent for managing pain in this population.

Impact of a Strategy for Improving Early Management of Acute Pain in the Pediatric Emergency Department

“…Despite this, we were able to find significant differences in the probability of receiving analgesia when the patient is attended by a traumatologist. The work by Schuman et al 17 showed a reduction in the time of analgesia administration in pediatric patients in the ED after the implementation of a standardized pain management protocol for patients presenting with musculoskeletal pain under a nurse-initiated order. In it, it was evidenced that the median time of medication administration decreased from 71.5 minutes before the protocol to 26 minutes after the implementation of the protocol.…”