Abstract
OBJECTIVE--To assess the use of analgesia in an accident and emergency (A&E) department and identify shortcomings. SETTING--University teaching hospital. METHODS--An audit of patients referred from the A&E department to orthopaedic fracture clinic (n = 100) or for orthopaedic admission (n = 100) was carried out to document analgesia use. An analgesia protocol was introduced and analgesia use was reassessed on the same numbers of patients. RESULTS--Prescribing of analgesia was initially poor: 91% of fracture clinic referrals and 39% of admissions received no analgesia while in the A&E department; when given, it was often by inappropriate routes. Introduction of an analgesia protocol significantly improved analgesia use: fracture clinic referrals receiving unsatisfactory analgesia were reduced from 91% to 69% (P < 0.001). There was a marked increase in the use of intravenous analgesia, from 9% to 37% (P < 0.001). CONCLUSIONS--Large numbers of patients still receive no analgesia while in the A&E department. This seems to be a common problem requiring intervention at a national level. The absence of a coordinated approach to improving analgesia provision for acute trauma in the United Kingdom should be addressed urgently.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Buckley M. M., Brogden R. N. Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential. Drugs. 1990 Jan;39(1):86–109. doi: 10.2165/00003495-199039010-00008. [DOI] [PubMed] [Google Scholar]
- Chambers J. A., Guly H. R. The need for better pre-hospital analgesia. Arch Emerg Med. 1993 Sep;10(3):187–192. doi: 10.1136/emj.10.3.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ducharme J. Emergency pain management: a Canadian Association of Emergency Physicians (CAEP) consensus document. J Emerg Med. 1994 Nov-Dec;12(6):855–866. doi: 10.1016/0736-4679(94)90498-7. [DOI] [PubMed] [Google Scholar]
- Melzack R., Wall P. D., Ty T. C. Acute pain in an emergency clinic: latency of onset and descriptor patterns related to different injuries. Pain. 1982 Sep;14(1):33–43. doi: 10.1016/0304-3959(82)90078-1. [DOI] [PubMed] [Google Scholar]
- Owen H., Mather L. E., Rowley K. The development and clinical use of patient-controlled analgesia. Anaesth Intensive Care. 1988 Nov;16(4):437–447. doi: 10.1177/0310057X8801600409. [DOI] [PubMed] [Google Scholar]
- Selbst S. M. Analgesia in children. Why is it underused in emergency departments? Drug Saf. 1992 Jan-Feb;7(1):8–13. doi: 10.2165/00002018-199207010-00003. [DOI] [PubMed] [Google Scholar]
- Todd K. H., Samaroo N., Hoffman J. R. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993 Mar 24;269(12):1537–1539. [PubMed] [Google Scholar]
- Wilson J. E., Pendleton J. M. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989 Nov;7(6):620–623. doi: 10.1016/0735-6757(89)90286-6. [DOI] [PubMed] [Google Scholar]