Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain.
OBJECTIVE
Acute pain is the most frequent complaint in emergency department (ED) admissions, but its management is often neglected, placing patients at risk of oligoanalgesia. We evaluate the effect of the implementation of guidelines for pain management in ED patients with pain at admission or anytime during their stay in our ED.


METHODS
This prospective pre-post intervention cohort study included data collection both before and after guideline implementation. Consecutive adult patients admitted with acute pain from any cause or with pain at any time after admission were enrolled. The quality of pain management was evaluated according to information in the ED medical records by using a standardized collection form, and its impact on patients was recorded with a questionnaire at discharge.


RESULTS
Two hundred forty-nine and 192 patients were included during pre- and postintervention periods. Pain was documented in 61% and 76% of nurse and physician notes, respectively, versus 78% and 85% after the intervention (difference 17%/9%; 95% confidence interval [CI] 8% to 26%/2% to 17%, respectively). Administration of analgesia increased from 40% to 63% (difference 23%; 95% CI 13% to 32%) and of morphine from 10% to 27% (difference 17%; 95% CI 10% to 24%). Mean doses of intravenous morphine increased from 2.4 mg (95% CI 1.9 to 2.9 mg) to 4.6 mg (95% CI 3.9 to 5.3 mg); administration of nonsteroidal antiinflammatory drugs and acetaminophen increased as well. There was a greater reduction of visual analogue scale score after intervention: 2.1 cm (95% CI 1.7 to 2.4 cm) versus 2.9 cm (95% CI 2.5 to 3.3 cm), which was associated with improved patient satisfaction.


CONCLUSIONS
Education program and guidelines implementation for pain management lead to improved pain management, analgesia, and patient satisfaction in the ED.
Decosterd
Isabelle
I
Department of Anesthesiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland. isabelle.decosterd@unil.ch
Hugli
Olivier
O
Tamchès
Emmanuel
E
Blanc
Catherine
C
Mouhsine
Elyazid
E
Givel
Jean-Claude
JC
Yersin
Bertrand
B
Buclin
Thierry
T
D000208:Acute Disease; D000328:Adult; D000698:Analgesia / Q000592:standards / Q000706:statistics & numerical data*; D003625:Data Collection; D004502:Education, Medical, Continuing; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013557:Switzerland