title: National project seeking to improve pain management in the emergency department setting: findings from the NHMRC-NICS National Pain Management Initiative.
abstract: OBJECTIVE
  The National Pain Management Initiative was established by the National Institute of Clinical Studies to improve analgesic practice across Australian EDs.
  
  
  METHODS
  A barrier analysis provided information to better implement changes in analgesic practice. A working party was established and developed a multifaceted intervention strategy and clinical indicators. An online data collection system was developed and sites collected data at three monthly intervals for 18 months. A stepped-wedge design was chosen to manage the number of hospitals involved. Clinical indicators included documentation of pain score, time to analgesia, appropriate use of parenteral narcotics and effectiveness of analgesia for severe pain.
  
  
  RESULTS
  A total of 16,627 patient datasets were entered from 45 metropolitan and regional hospitals. There was an increase from 41% to 64% in documented pain score (difference in proportions 23%, 95% confidence interval: 20-26) and median time to analgesia fell from 61 min (interquartile range: 23-122) to 41 min (interquartile range: 15-95). Appropriate parenteral narcotic use was over 90% for all time points combined. For all patients with severe pain there was no significant change in the proportion with a documented reduction of pain within 1 h of presentation.
  
  
  CONCLUSIONS
  Significant improvements in documentation of pain score and time to analgesia were demonstrated through a national project of targeted improvement. Parenteral narcotic use has a high level of adherence to recommended practice. An improvement in the effectiveness of analgesia in severe pain has not been clearly demonstrated in this study.
authors.affiliation: Emergency Department, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Doherty
authors.forename: Jonathan
authors.initials: J
authors.lastname: Knott
authors.forename: Scott
authors.initials: S
authors.lastname: Bennetts
authors.forename: Mitra
authors.initials: M
authors.lastname: Jazayeri
authors.forename: Sue
authors.initials: S
authors.lastname: Huckson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009313:National Health Programs; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000706:statistics & numerical data; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D014600:Utilization Review; D055815:Young Adult