How the intervention works | |
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1. Changing subjective measurement of pain into an objective measure by using pain scoring tools | Pain is a subjective measure that is difficult to assess, and there are differences in the estimation of pain by clinicians, nurses and patients.58 In order to be treated properly, pain needs to be assessed by an objective, validated pain-scoring tool that can be understood by patients, clinical and nursing staff. The use of pain-scoring tools should, therefore, improve ED staff awareness of patients’ pain and allow them to administer analgesia accordingly. |
2. Removing structural barriers that lead to delays in provision of analgesia | Barriers to timely analgesia include physical access barriers and delays associated with the need for medical staff to assess and prescribe opioids and other narcotics. Structural changes to the ED, as well as changes to the nursing role (eg, nurse-initiated analgesia), should improve pain management, as nursing staff have a lower turnover, a greater belief and desire for change in practice, and are more able to estimate patient's pain than medical staff.42 45 |
3. Removing attitudinal and knowledge barriers to the management of pain | ED staff receive very little training about the importance of pain management, and a lack of knowledge and misbeliefs around pain management are seen as barriers to the delivery of appropriate analgesia. Educational interventions should, therefore, help to increase ED staff understanding of the theory behind pain management and enable them to improve the management of pain. Similarly, pain protocols should decrease staff uncertainty and provide information as to how to manage pain and offer appropriate analgesia. |
4. Combining different methods of improving behaviour change to address different aspects of poor pain management | The reasons for poor pain management are multiple and complex and, therefore, need addressing with a multifaceted intervention which involves a combination of methods (eg, protocol with education and pain scoring) to maximise behaviour change around pain management. Problems may be department-specific, and can best be resolved by individualised interventions taking into account the needs of the department. A combination of these methods may lead to increased effectiveness, as seen in other contexts8 |
5. Understanding how pain can be managed better within an individual department by developing interventions based upon diagnostic analysis of the problems within that department. | Research in other settings suggests that interventions attempting to change behaviour should involve a ‘diagnostic analysis’ to identify barriers and factors likely to affect change.10 Studies that have undertaken research or audit in their departments and developed interventions based on a strong theoretical framework are more likely to address barriers to pain management and, therefore, achieve an improvement in pain management within their ED. |
ED, emergency department.