The efficacy of an educational intervention on documentation of pain management for the elderly patient with a hip fracture in the emergency department

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 chi(2) test showed that there was no significant difference [chi(2) (1, N = 110), 1.48; P = .223] for the documentation for time to treatment (<60 minutes). However, a chi(2) analysis [chi(2) (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.