Acute pain in adults admitted to the emergency room: development and implementation of abbreviated guidelines.
OBJECTIVE
Although acute pain is frequently reported by patients admitted to the emergency room, it is often insufficiently evaluated by physicians and is thus undertreated. With the aim of improving the care of adult patients with acute pain, we developed and implemented abbreviated clinical practice guidelines (CG) for the staff of nurses and physicians in our hospital's emergency room.


METHODS
Our algorithm is based upon the practices described in the international literature and uses a simultaneous approach of treating acute pain in a rapid and efficacious manner along with diagnostic and therapeutic procedures.


RESULTS
Pain was assessed using either a visual analogue scale (VAS) or a numerical rating scale (NRS) at ER admission and again during the hospital stay. Patients were treated with paracetamol and/or NSAID (VAS/NRS <4) or intravenous morphine (VAS/NRS > or =04). The algorithm also outlines a specific approach for patients with headaches to minimise the risks inherent to a non-specific treatment. In addition, our algorithm addresses the treatment of paroxysmal pain in patients with chronic pain as well as acute pain in drug addicts. It also outlines measures for pain prevention prior to minor diagnostic or therapeutic procedures.


CONCLUSIONS
Based on published guidelines, an abbreviated clinical algorithm (AA) was developed and its simple format permitted a widespread implementation. In contrast to international guidelines, our algorithm favours giving nursing staff responsibility for decision making aspects of pain assessment and treatment in emergency room patients.
Tamchès
Emmanuel
E
Centre Interdisciplinaire des Urgences, CHUV, Lausanne.
Buclin
Thierry
T
Hugli
Olivier
O
Decosterd
Isabelle
I
Blanc
Catherine
C
Mouhsine
Elyaside
E
Givel
Jean-Claude
JC
Yersin
Bertrand
B
D000082:Acetaminophen / Q000627:therapeutic use; D000208:Acute Disease; D000465:Algorithms; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003663:Decision Trees; D004636:Emergency Service, Hospital; D006801:Humans; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D019966:Substance-Related Disorders / Q000175:diagnosis; D013557:Switzerland
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine