Improving Early Acute Pain Management in an Academic Tertiary Centre Emergency Department

K Nixon1, 2 G Martin1 M McGowan1 D MacKinnon1, 2 K Gaunt1 G Bandiera1 L Barratt1 E Nagatu1 N Ahmed2 M Bawazeer2 and J Spence1

on behalf of the St. Michael’s Hospital Department of Emergency Medicine1 and Trauma Program2

ContextEarly Acute Pain Management in the ED

• Significant number of patients come to the Emergency Department with acute pain; however, assessing and treating acute pain may not always be as timely as staff and patients wish with competing clinical priorities and limitations of space and volume

Problem and Issue• Best practices suggest that pain management for the

emergency and trauma patient should be a priority in order to prevent complications of acute pain and maintain the validity of clinical assessment findings; however, under-treatment of acute pain (oligoanalgesia) is well documented and is a common source for patient dissatisfaction

• Pain is a dimension of patient satisfaction that is measured with the validated NRC Picker; however, caution must be heeded with interpretation - low response rate, patient recall and precludes those with mental illness, homeless/sheltered and admitted to hospital

MeasurementPain Management Beliefs. 45-question survey on knowledge of pain management

Patient is most accurate judge of intensity of pain communicated reliably with a 10-point scale (MD 74%, RN 67%)

Pain management is of equal priority with other aspects of clinical care (RN 85%, MD 77%); however staff estimated only 51-75% achieved pain relief satisfaction (RN 46%, MD 38%)

Early Acute Pain Management in the ED

Figure 1. Reason for Inadequate Pain Management Additional barriers to effective pain management were clinical volume, work load and waiting for diagnostics or adequate treatment space

Patient Report. 10-question survey insitu.54% perceived minimal delay until Emergency staff (MD 43%, RN 31%, both 8%) discussed pain relief, with medication options being most prominent (80%); perception of adequate pain relief (yes 42%, no 31%) was mixed though most (79%) felt staff were doing everything they could

Contribution to Patient Safety & Quality Improvement• Quality patient care includes providing early and

effective pain management

• A best-practices informed standardized medication order set was implemented and facilitates safe prescribing and timely administration of opioids for acute pain in the Emergency Department.

• A collaborative approach, engaging the expertise and champions from the Acute Pain Service, Pharmacy, Nursing Professional Practice, Quality & Risk Management, Emergency Nursing, General Surgery and the Emergency and Trauma management and physician groups has led to enhanced monitoring of process, quality indices and engagement with the patient experience

Early Acute Pain Management in the ED