title: A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain.
abstract: While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre- (15 months, n = 504) and post-period (6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain (NRS ≥4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min (P < 0.05), whereas time to opioids decreased from 37 to 15 min (P < 0.01). Mean pain relief significantly increased to 1.56 NRS-points, in patients who received analgesic treatment even up to 2.02 points. The protocol appeared to lead to an increase in analgesic administration, shorter time to analgesics and a higher clinically relevant pain relief. Despite improvements, suffering moderate to severe pain at ED discharge was still common. Protocol adherence needs to be studied in order to optimize pain management.
authors.affiliation: Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Drienerlolaan 5, P.O. Box 217, 7522 NB, Enschede, Netherlands. Electronic address: j.g.j.pierik@utwente.nl.
authors.forename: Jorien G J
authors.initials: JG
authors.lastname: Pierik
authors.affiliation: Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Health and Social Studies, Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, Netherlands.
authors.forename: Sivera A
authors.initials: SA
authors.lastname: Berben
authors.affiliation: Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Drienerlolaan 5, P.O. Box 217, 7522 NB, Enschede, Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
authors.affiliation: Emergency Department, Admiraal De Ruyter Ziekenhuis, Goes, Netherlands.
authors.forename: Menno I
authors.initials: MI
authors.lastname: Gaakeer
authors.affiliation: Ambulance Oost, Hengelo, Netherlands; Anesthesiology, Ziekenhuisgroep Twente, Almelo, Netherlands.
authors.forename: Fred L
authors.initials: FL
authors.lastname: van Eenennaam
authors.affiliation: Emergency Department, Medisch Spectrum Twente, Enschede, Netherlands.
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.affiliation: Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Drienerlolaan 5, P.O. Box 217, 7522 NB, Enschede, Netherlands.
authors.forename: Carine J M
authors.initials: CJ
authors.lastname: Doggen
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D004008:Diclofenac / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D059352:Musculoskeletal Pain / Q000188:drug therapy* / Q000451:nursing; D009426:Netherlands; D059408:Pain Management / Q000379:methods / Q000451:nursing* / Q000592:standards / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D004008:Diclofenac; D000082:Acetaminophen; D014147:Tramadol; D009020:Morphine; D008874:Midazolam; D005283:Fentanyl
keywords: Acute musculoskeletal pain; Analgesics; Clinically relevant pain relief; Emergency department; Nurse-initiated pain protocol