Abstract
Objectives: To ascertain if the use of a structured pain assessment tool and nurse initiated oral analgesia protocols improve uptake and time to analgesia for children presenting to the emergency department with minor or moderate musculoskeletal injuries.
Methods: Three groups of children with peripheral limb injuries were examined to identify the rates of analgesia provision and time from attendance to analgesia provision. These groups corresponded to an initial group with no pain scoring and physician initiated analgesia, a second group with pain scoring at triage then physician initiated analgesia, and a third group with pain scoring and nurse initiated analgesia.
Results: The mean time to analgesia in the initial group was 138 minutes. After initiation of triage pain assessment the mean time to analgesia was 93 minutes, there was no statistical difference between these two groups. After the introduction of nurse initiated analgesia, the time to analgesia fell to a mean of 46 minutes. The rate of analgesia provision was initially 20.5% while after the initiation of triage pain assessment the provision rate was 23%. After the initiation of nurse initiated analgesia the analgesia provision rate significantly rose to 34% of attendances.
Conclusions: The use of a nurse initiated, oral analgesia protocol for treatment of children with mild to moderate injury can significantly increase analgesia provision rates and decrease time to provision of analgesia.
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Selected References
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- Anand K. J., Hickey P. R. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987 Nov 19;317(21):1321–1329. doi: 10.1056/NEJM198711193172105. [DOI] [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]
- Fry Margaret, Holdgate Anna. Nurse-initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia. Emerg Med (Fremantle) 2002 Sep;14(3):249–254. doi: 10.1046/j.1442-2026.2002.00339.x. [DOI] [PubMed] [Google Scholar]
- Goodacre S. W., Roden R. K. A protocol to improve analgesia use in the accident and emergency department. J Accid Emerg Med. 1996 May;13(3):177–179. doi: 10.1136/emj.13.3.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kelly A. M. A process approach to improving pain management in the emergency department: development and evaluation. J Accid Emerg Med. 2000 May;17(3):185–187. doi: 10.1136/emj.17.3.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Maurice S. C., O'Donnell J. J., Beattie T. F. Emergency analgesia in the paediatric population. Part I: current practice and perspectives. Emerg Med J. 2002 Jan;19(1):4–7. doi: 10.1136/emj.19.1.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Porter J., Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980 Jan 10;302(2):123–123. doi: 10.1056/nejm198001103020221. [DOI] [PubMed] [Google Scholar]
- Schechter N. L., Allen D. A., Hanson K. Status of pediatric pain control: a comparison of hospital analgesic usage in children and adults. Pediatrics. 1986 Jan;77(1):11–15. [PubMed] [Google Scholar]
- Schechter N. L., Allen D. Physicians' attitudes toward pain in children. J Dev Behav Pediatr. 1986 Dec;7(6):350–354. [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]
- Selbst S. M., Clark M. Analgesic use in the emergency department. Ann Emerg Med. 1990 Sep;19(9):1010–1013. doi: 10.1016/s0196-0644(05)82565-x. [DOI] [PubMed] [Google Scholar]
- Somers L. J., Beckett M. W., Sedgwick P. M., Hulbert D. C. Improving the delivery of analgesia to children in pain. Emerg Med J. 2001 May;18(3):159–161. doi: 10.1136/emj.18.3.159. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yaster M., Deshpande J. K. Management of pediatric pain with opioid analgesics. J Pediatr. 1988 Sep;113(3):421–429. doi: 10.1016/s0022-3476(88)80622-x. [DOI] [PubMed] [Google Scholar]