Original article

A process approach to improving pain management in the emergency department: development and evaluation

Anne-Maree Kelly

Department of Emergency Medicine, Western Hospital, Private Bag, Footscray 3011, Australia

Correspondence to:
Correspondence to: Professor Kelly (e-mail: Anne-Maree.Kelly{at}nwhcn.org.au)

Aim—(1) To describe a process approach to the improvement of pain management in emergency departments. (2) To compare analgesia ordering and administration practices for patients with acute fractures before and after implementation of a nurse managed, titrated intravenous narcotic policy.

Method—Retrospective chart review of patients with long bone fractures for the years 1993 and 1997.

Results—There was a dramatic change in analgesia administration practices away from the intramuscular route in favour of the intravenous route (p<0.001). For long bone fractures, in 1993, 53% of patients received intramuscular narcotic analgesia compared with 5% in 1997. In contrast, in 1993, 6% of the patients received intravenous narcotic analgesia compared with 54% in 1997.

Conclusion—This study demonstrates that a process approach to improving pain management that resulted in both changes in drug administration and pain assessment and management processes made a significant and sustained change to analgesia ordering and administration practices for patients with long bone fractures in an emergency department.

Keywords: pain managment

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