title: Actions to improve documented pain assessment in adult patients with injury to the upper extremities at the Emergency Department - A cross-sectional study.
abstract: BACKGROUND
  Pain is one of the most common symptoms in the Emergency Department (ED) and is the cause of more than half of the visits to the ED. Several attempts to improve pain management have been done by using, for example, standards/guidelines and education. To our knowledge no one has investigated if and how different actions over a longitudinal period affect the frequency of pain documentation in the ED. Therefore the aim of this study was to describe the frequency of documented pain assessments in the ED.
  
  
  METHODS
  A cross-sectional study during 2006-2012 was conducted. The care of patients with wrist/arm fractures or soft tissue injuries on upper extremities was evaluated.
  
  
  RESULTS
  Despite various actions our result shows that mandatory pain assessment in the patient's computerized medical record was the only successful intervention to improve the frequencies of documentation of pain assessment during care in the ED. During the study period, no documentation of reassessment of pain was found despite the fact that all patients received pain medication.
  
  
  CONCLUSIONS
  To succeed in increasing the frequency of documented pain assessment, mandatory pain rating is a successful action. However, the re-evaluation of documented pain assessment was nonexisting.
authors.affiliation: Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. Electronic address: lars.sturesson@sodersjukhuset.se.
authors.forename: L
authors.initials: L
authors.lastname: Sturesson
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Academic EMS, Stockholm, Sweden.
authors.forename: V
authors.initials: V
authors.lastname: Lindström
authors.affiliation: Department of Clinical Science and Education, Section of Emergency Medicine, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; HUCH Emergency Care, Helsinki University Hospital, Helsinki University, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Castrén
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Niemi-Murola
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Intensive Care Unit, Karolinska University Hospital, Solna, Sweden.
authors.forename: A-C
authors.initials: AC
authors.lastname: Falk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004282:Documentation / Q000592:standards*; D057286:Electronic Health Records; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000451:nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000451:nursing / Q000592:standards*; D034941:Upper Extremity / Q000293:injuries*
keywords: Acute pain; Documentation; Emergency care; Evidence based care; Guidelines; Pain assessments; Pain management