Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department

Abstract

Objective To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). Methods We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint. The study sample was randomly selected from a list of all eligible patients. Data were extracted electronically from the ED records and by explicit extraction from the medical record. Logistic regression models were constructed to assess associations with the three binary study end points. Results 1289 patients were enrolled. Patients were less likely to receive any analgesia if they presented 08:00-15:59 hours (OR 0.67, 95% CI 0.46 to 0.98) or 16:00-24:00 hours (OR 0.55, 95% CI 0.37 to 0.80) were triage category 5 (OR 0.20, 95% CI 0.08 to 0.49) or required an interpreter (OR 0.34, 95% CI 0.14 to 0.86). Patients were less likely to receive NIA or early analgesia if they were aged 56 years or more (OR 0.70 and 0.63; OR 0.57 and 0.21, respectively) or if they had received ambulance analgesia (OR 0.59, 95% CI 0.36 to 0.95; OR 0.38, 95% CI 0.20 to 0.74, respectively). Conclusions Patients who present during the daytime, have a triage category of 5 or require an interpreter are less likely to receive analgesia. Older patients and those who received ambulance analgesia are less likely to receive NIA or early analgesia.

Assessment of adequacy and appropriateness of pain management practice among trauma patients at the Ethiopian Aabet Hospital: A prospective observational study

“…The present study found that mean time of the first analgesia was 94.7 minutes which was much higher than studies done in US, Canada, Australia, Iran and Netherlands in which the mean time of analgesia for most setting in ER was 78 minutes [ 7 , 9 , 27 , 40 – 42 ]. Study in Gondar, Ethiopia in trauma and non-trauma patients revealed the mean time to delivery of analgesia was 61 minutes [ 5 ].…”

“…However, the prevalence of patients who received the first analgesia within 30 minutes in this study was only 9.1%. Study in Gondar, Ethiopia in trauma and non-trauma patients also revealed that only 12.3% of patients received analgesia within 30 minutes of ED presentation [ 5 ] A comparable finding (19.2%) was reported from a study done in Australia [ 40 ]. Nevertheless, a higher prevalence (61.3%) than the current study was obtained from another study done in Australia [ 41 ].…”

Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study

“…Observations will be recorded as field notes to capture understandings of how emergency nurses detect, assess and manage acute pain in critically ill patients in everyday practice [ 52 ]. There are a lack of studies using observation to identify nurse-initiated analgesia, its safety and impact on patient outcomes; most data collection techniques have included survey/questionnaire [ 35 , 39 , 53 ], interview [ 37 , 54 , 55 ] or audits [ 21 , 24 , 36 , 37 , 39 , 56 – 58 ]. These methods however reflect only reported, not observed actual practice.…”

Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management

“…However, after these publications, numerous researchers in different settings have conducted studies with results indicating that patients are still at risk of oligoanalgesia (Arendts & Fry, 2006;Daoust, Paquet, Lavigne, Sanogo, & Chauny, 2014;Hwang, Richardson, Harris, & Morrison, 2010;Ko et al, 2016;Platts-Mills et al, 2012). Oligoanalgesia may also occur in the ED setting (Todd et al, 2007); trauma patients' ≥65 years of age are less likely to receive analgesia than younger patients (Quattromani et al, 2015;Taylor et al, 2017). Cognitively impaired patients have an increased risk of undertreated acute pain (Green & Bernoth, 2016;Morrison & Siu, 2000).…”