title: A process approach to improving pain management in the emergency department: development and evaluation.
abstract: OBJECTIVE
  (1) To describe a process approach to the improvement of pain management in emergency departments. (2) To compare analgesia ordering and administration practices for patients with acute fractures before and after implementation of a nurse managed, titrated intravenous narcotic policy.
  
  
  METHODS
  Retrospective chart review of patients with long bone fractures for the years 1993 and 1997.
  
  
  RESULTS
  There was a dramatic change in analgesia administration practices away from the intramuscular route in favour of the intravenous route (p<0.001). For long bone fractures, in 1993, 53% of patients received intramuscular narcotic analgesia compared with 5% in 1997. In contrast, in 1993, 6% of the patients received intravenous narcotic analgesia compared with 54% in 1997.
  
  
  CONCLUSIONS
  This study demonstrates that a process approach to improving pain management that resulted in both changes in drug administration and pain assessment and management processes made a significant and sustained change to analgesia ordering and administration practices for patients with long bone fractures in an emergency department.
authors.affiliation: Department of Emergency Medicine, Western Hospital, Australia. Anne-Maree.Kelly@nwhcn.org.au
authors.forename: A M
authors.initials: AM
authors.lastname: Kelly
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D001315:Australia; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D059408:Pain Management; D010147:Pain Measurement; D017064:Process Assessment, Health Care
chemical_list: D000700:Analgesics