Research
The Efficacy of an Educational Intervention on Documentation of Pain Management for the Elderly Patient With a Hip Fracture in the Emergency Department

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Introduction

Pain is one of the foremost reasons that patients appear in the emergency department. Documentation of pain levels may be difficult to determine because the elderly patient with a hip fracture may have an alteration in the clinical presentation because of hearing deficits, impaired cognitive functioning, or chronic disease processes. The intent of this research project was to explore the results of a staff educational intervention with evaluation of medical record documentation before and after implementation.

Methods

An educational intervention for staff included a review of hospital pain policies/protocols, documentation required, and elderly physiologic and psychological systems relating to the treatment of acute pain. Documentation was audited before and after educational intervention.

Results

A χ2 test showed that there was no significant difference [χ2 (1, N = 110), 1.48; P = .223] for the documentation for time to treatment (<60 minutes). However, a χ2 analysis [χ2 (1, N = 149), 8.315, P = .004] showed that there was a statistically significant difference as a result of the educational intervention for the documentation of pain levels in a timely manner after analgesic treatment.

Discussion

Educational interventions may be used to facilitate documentation of patient’s pain. Barriers to medical recording need to be addressed to improve the proficiency of the registered nurse in the emergency department. Performance measures are entwined with competency levels for health care workers and standards of care delivery. A continuous and ongoing effort to facilitate the best practice for patients is a major initiative without an endpoint.

Section snippets

Methods

Before the educational intervention, a retroactive chart audit was completed from January through August 2006. The patient population included patients aged older than 65 years, male or female, with the diagnosis of a hip fracture admitted to the emergency department. A population of 151 patients was selected. The educational intervention was completed in September and October 2006. The chart audit was thus completed after the educational intervention from January through July 2007 until 151

Results

There were 302 hip fracture cases included within the study, of which 25% were in men (78 patients) and 74% in women (224 patients). The mean age was 83 years (SD, 7.25 years; range, 65-99 years). The month with the highest number of elderly patients admitted with a hip fracture was March, with 24 admissions. The most commonly used analgesic was hydromorphone, which was given in 32% of patients (98 cases); morphine, which was given in 29% of patients (90 cases), was the second most commonly

Discussion

One of the potential barriers to appropriate monitoring and treatment of pain is the lack of documentation that would prompt the health care advocate to administer an effective analgesic. Comparable to this study, there frequently were pain assessments completed upon admission to the emergency department, but the follow-up to assess the impact of analgesic therapy was at times incomplete.18 The Valley Hospital provides the proper tools for the health care advocate to assess and monitor the

Limitations

Future research should include a perception questionnaire before an educational intervention to rule out any misperceptions of staff and thus guide the information to be provided to staff to clarify any myths. The identification of specific health care personnel documentation before and after chart review would provide educational guidance individualized for each registered nurse.

Implications for Emergency Nurses

Patients should have their pain relieved as a bare minimum standard of care. The American Pain Society and the Joint Commission have developed standards of care for the assessment and management of pain within hospitals and other health care settings.29 Performance measures are entwined with competency levels for health care workers and standards of care delivery. A continuous and ongoing effort to facilitate the best practice possible for our patients is a major initiative without an endpoint.

Conclusions

This research study shows the positive aspects of educational interventions and documentation compliance for the patient with a hip fracture admitted to the emergency department at the Valley Hospital. The outcomes of this study will guide future compliance issues concerning documentation by applying the principles of educational preparation and reinforcement to provide incentives for improved staff performance.

Susan E. Jackson, Member, Northern Chapter, is Advanced Practice Nurse, Trinitas Hospital, Elizabeth, NJ. At the time this article was written, Dr. Jackson was Emergency Department Nurse, The Valley Hospital, Ridgewood, NJ.

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  • Cited by (0)

    Susan E. Jackson, Member, Northern Chapter, is Advanced Practice Nurse, Trinitas Hospital, Elizabeth, NJ. At the time this article was written, Dr. Jackson was Emergency Department Nurse, The Valley Hospital, Ridgewood, NJ.

    No funding or grants were received for this project from any source.

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