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National project seeking to improve pain management in the emergency department setting: Findings from the NHMRC‐NICS N ational P ain M anagement I nitiative
Author(s) -
Doherty Steven,
Knott Jonathan,
Bennetts Scott,
Jazayeri Mitra,
Huckson Sue
Publication year - 2013
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12022
Subject(s) - interquartile range , medicine , narcotic , emergency department , narcotic analgesics , analgesic , documentation , pain relief , confidence interval , univariate analysis , pain management , morphine , anesthesia , emergency medicine , multivariate analysis , nursing , computer science , programming language
Objectives The N ational P ain M anagement I nitiative was established by the N ational I nstitute of C linical S tudies to improve analgesic practice across A ustralian EDs . Methods A barrier analysis provided information to better implement changes in analgesic practice. A working party was established and developed a multifaceted intervention strategy and clinical indicators. An online data collection system was developed and sites collected data at three monthly intervals for 18 months. A stepped‐wedge design was chosen to manage the number of hospitals involved. Clinical indicators included documentation of pain score, time to analgesia, appropriate use of parenteral narcotics and effectiveness of analgesia for severe pain. Results A total of 16 627 patient datasets were entered from 45 metropolitan and regional hospitals. There was an increase from 41% to 64% in documented pain score (difference in proportions 23%, 95% confidence interval: 20–26) and median time to analgesia fell from 61 min (interquartile range: 23–122) to 41 min (interquartile range: 15–95). Appropriate parenteral narcotic use was over 90% for all time points combined. For all patients with severe pain there was no significant change in the proportion with a documented reduction of pain within 1 h of presentation. Conclusion Significant improvements in documentation of pain score and time to analgesia were demonstrated through a national project of targeted improvement. Parenteral narcotic use has a high level of adherence to recommended practice. An improvement in the effectiveness of analgesia in severe pain has not been clearly demonstrated in this study.