title: Increased analgesia administration in emergency medicine after implementation of revised guidelines.
abstract: BACKGROUND
  The most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management.
  
  
  METHODS
  We conducted a prospective pre-post intervention cohort study with implementation of a revised guideline for pain management at our ED, in which nurses are allowed to administer analgesia (including low-dosage piritramid (opioid) intravenous) without doctor intervention. Numeric Rating Scales (NRS) were measured, and administration of medication (main outcome) was documented. We included every adult patient presenting with pain (NRS 4-10) at the ED.
  
  
  RESULTS
  A total of 2107 patients (1089 pre-implementation phase and 1018 post-implementation phase) were included in our study. During pre-implementation, 25.4 % of the patients with NRS between 4 and 10 received analgesia. After implementation, 32.0 % of these patients received analgesia (p < 0.001).
  
  
  CONCLUSIONS
  After implementation of the revised guidelines in pain management at the ED, the administration of pain medication increased significantly. Nevertheless, the percentage of patients in pain receiving analgesia remain low (32 % after implementation).
authors: Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands. geesjevanwoerden@hotmail.com.
authors: Geesje
authors: G
authors: Van Woerden
authors: Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands. c.vandenbrand@mchaaglanden.nl.
authors: Crispijn L
authors: CL
authors: Van Den Brand
authors: Department of Anaesthesiology, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands. k.den.hartog@mchaaglanden.nl.
authors: Cornelis F
authors: CF
authors: Den Hartog
authors: Department of Surgery, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands. f.idenburg@mchaaglanden.nl.
authors: Floris J
authors: FJ
authors: Idenburg
authors: Landsteiner Institute, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands. diana.grootendorst@landsteiner.nl.
authors: Diana C
authors: DC
authors: Grootendorst
authors: Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands. c.van.der.linden@mchaaglanden.nl.
authors: M Christien
authors: MC
authors: Van Der Linden
keywords: Acute pain; Analgesics; Emergency department; Pain management