Acute pain management in adult patients in the emergency department 10 years after implementation of a nurse-initiated pain-management protocol, a prospective observational study.

Abstract

Background: Although acute pain is one of the most common complaints in the emergency department (ED), it is often undertreated. Several interventions, such as the implementation of an acute pain protocol, have been evaluated in order to optimize pain management, with variable results. The aim of this study was to evaluate the long-term efficacy of a nurse-initiated pain-management protocol 10 years after implementation.

Methods: This was a prospective, observational study recruiting all consecutive adult patients with acute pain in the ED of a Level-1 trauma center during a period of 4 weeks. The primary outcome was the percentage of the composite endpoint 'pain awareness'. The secondary outcomes were patient satisfaction; administration of analgesics; NRS scores and waiting time until receiving analgesics.

Results: Three hundred and 23 patients were included in this study. The percentage of pain awareness was 69 %. In 41.5 % of patients, analgesics were administered and in 55.1 %, an NRS-score was documented. Regarding patient satisfaction, no significant correlation was observed between waiting time until receiving analgesics and satisfaction.

Discussion: The percentage of pain awareness was 69 % with an existing pain protocol in place. Overall, patient satisfaction was positive in the majority of the patients. Further research into the types of analgesics that are more likely to optimize the protocol is necessary.