title: Pharmacist's impact on acute pain management during trauma resuscitation.
abstract: The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.
authors.affiliation: Department of Emergency Medicine, Lakeland Regional Medical Center, Lakeland, Florida (Drs Montgomery, Hall, and Keriazes).
authors.forename: Kayla
authors.initials: K
authors.lastname: Montgomery
authors.forename: A Brad
authors.initials: AB
authors.lastname: Hall
authors.forename: Georgia
authors.initials: G
authors.lastname: Keriazes
mesh_terms: D000208:Acute Disease; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D010595:Pharmacists; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012380:Role; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid