Undertreatment of acute pain in the emergency department: a challenge.
OBJECTIVE
Evaluation and improvement of pain management in our emergency department (ED).


METHODS
This was a "before-after" study. For each subject, the nurse, the physician, and the patient were asked to rate the initial intensity of the pain on a Visual Analogue Score (VAS). The timing and the type of analgesics administered were then recorded and follow-up VAS was performed.


METHODS
A teaching, community-based, 400-bed hospital.


METHODS
140 patients admitted for acute pain related to orthopedic injuries.


METHODS
The gap between the VAS expressed by the patient and estimated by the staff, the proportion of patients receiving analgesics, and the length of time delays between admission and analgesic administration.


METHODS
The intervention included education of medical and nursing staffs, insertion of a VAS template in the patient's chart, initiation of routine VAS assessment and re-assessment, and implementation of a protocol for pain management with standing orders for nurses.


RESULTS
The VAS gap between the patient and the nurse decreased significantly from 1.91 2.04 to 1.03 1.97 after the intervention (P = 0.01). The percentage of patients receiving analgesics rose from 70 to 82% following the intervention. Time from admission to analgesia decreased from 80 +/- 68 min (mean +/- SD) before the intervention, to 58 +/- 37 min after the intervention (P = 0.05).


CONCLUSIONS
Inadequate pain management in the ED appears related to poor staff assessment of pain and may be improved by routine VAS recording and by a nurse-based pain protocol.
Stalnikowicz
Ruth
R
Emergency Department, Hadassah University Hospital Mount Scopus, PO Box 24035, Jerusalem 91240, Israel. darvasi@md.huji.ac.il
Mahamid
Riad
R
Kaspi
Sigalit
S
Brezis
Mayer
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D017723:Drug Utilization Review; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D019370:Observation; D009985:Orthopedics / Q000592:standards*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement; D011446:Prospective Studies; D011785:Quality Assurance, Health Care
D000700:Analgesics