Acute pain in the emergency department: Effect of an educational intervention

AbstractBackground and aimsPain management is often inadequate in emergency departments (ED) despite the availability of effective analgesics. Interventions to change professional behavior may therefore help to improve the management of pain within the ED. We hypothesized that a 2-h educational intervention combining e-learning and simulation would result in improved pain treatment of ED patients with pain.MethodsData were collected at the ED of Horsens Regional Hospital during a 3-week study period in March 2015. Pain intensity (NRS, 0–10) and analgesic administration were recorded 24 h a day for all patients who were admitted to the ED during the first and third study weeks. Fifty-three ED nurses and 14 ED residents participated in the educational intervention, which took place in the second study week.ResultsIn total, 247 of 796 patients had pain >3 on the NRS at the admission to the ED and were included in the data analysis. The theoretical knowledge of pain management among nurses and residents increased as assessed by a multiple choice test performed before and after the educational intervention (P = 0.001), but no change in clinical practice could be observed: The administration for analgesics [OR: 1.79 (0.97–3.33)] and for opioids [2.02 (0.79–5.18)] were similar before and after the educational intervention, as was the rate of clinically meaningful pain reduction (NRS >2) during the ED stay [OR: 0.81 (CI 0.45–1.44)].ConclusionsConduction of a 2-h educational intervention combining interactive case-based e-learning with simulation-based training in an ED setting was feasible with a high participation rate of nurses and residents. Their knowledge of pain management increased after completion of the program, but transfer of the new knowledge into clinical practice could not be found. Future research should explore the effects of repeated education of healthcare providers on pain management.ImplicationsIt is essential for nurses and residents in emergency departments to have the basic theoretical and practical skills to treat acute pain properly. A modern approach including e-learning and simulation lead to increased knowledge of acute pain management. Further studies are needed to show how this increased knowledge is transferred into clinical practice.

Download Full-text

Impact of a blended curriculum on nursing handover quality: a quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2020-001024 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001024

Author(s):

Xavier Losfeld ◽

Laure Istas ◽

Quentin Schoonvaere ◽

Michel Vergnion ◽

Jochen Bergs

Keyword(s):

Educational Intervention ◽

Patient Information ◽

Professional Communication ◽

Fit Indices ◽

Negative Consequences ◽

Improvement Project ◽

Face To Face ◽

Before And After ◽

Post Test ◽

E Learning

Context and objectiveThe negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is, however, lacking. This study investigates the effect of a tailored, blended curriculum on nurses’ perception of handover quality.MethodsWe used a pre-test/post-test design within four units of a Belgian general hospital. Our educational intervention consisted of an e-learning module on professional communication and a face-to-face session on the use of a structured method for handovers. All nurses completed this blended curriculum (n=87). We used the Handover Evaluation Scale (HES) to evaluate nurses’ perception of handover quality before and after the intervention. The HES was answered by 87.4% of the nurses (n=76 of 87) before and 50.6% (n=44 of 87) after the intervention. Confirmatory factor analysis was used to assess the validity of the HES.ResultsThe original factor structure did not fit with our data. We identified a new HES structure with acceptable or good fit indices. The overall internal consistency of our HES structure was considered adequate. Perception of nurses on Relevance of information showed a significant improvement (M=53.19±4.33 vs M=61.03±6.01; p=0.04). Nurses also felt that the timely provision of patient information improved significantly (M=4.50±0.34 vs M=5.16±0.40; p=0.01).ConclusionThe applied intervention resulted in an improved awareness on the importance of Relevance of information during handovers. After our intervention, the nurses’ perception of the HES item ‘Patient information is provided in a timely manner’ also improved significantly. We are aware that the educational intervention is only the first step to achieve the long-term implementation of a culture of professional communication based on mutual support.

Download Full-text

Focused educational intervention improves but may not sustain knowledge regarding falls management

BMJ Open Quality ◽

10.1136/bmjoq-2017-000222 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000222 ◽

Cited By ~ 6

Author(s):

Punith Kempegowda ◽

Joht Singh Chandan ◽

Richard Hutton ◽

Lauren Brown ◽

Wendy Madden ◽

...

Keyword(s):

Clinical Practice ◽

Educational Intervention ◽

Educational Interventions ◽

Alternative Methods ◽

Junior Doctors ◽

Improvement Project ◽

Preventative Measures ◽

Before And After ◽

Hospital Stays ◽

Falls Management

BackgroundThe number of falls in hospital ranges from 3.8 to 8.6 falls per 1000 bed days. 1 Around 30% of falls as inpatients are injurious, and 4%–6% can result in serious and life-threatening injury. 2 3 This results in significant health burdens and economic burdens due to increased hospital stays following a fall. Junior doctors are usually the first point of contact for managing patients who fall in hospital. It is therefore important they understand the preventative measures and postfalls management.AimTo assess the retention of knowledge regarding falls management in foundation year 1 (FY1) doctors before and after a short educational intervention.MethodsA 3-stage quality improvement project was conducted at a West Midlands teaching hospital to highlight issues regarding falls management. A questionnaire assessing areas of knowledge regarding assessment and management of falls was delivered to 31 F1s. This was followed by a short presentation regarding falls management. The change in knowledge was assessed at 6 and 16 weeks postintervention. The questionnaire results were analysed using unpaired t-tests on STATA (V.14.2).ResultsThe mean score for knowledge regarding falls management in the preintervention, early postintervention and late postintervention were 73.7%, 85.2% and 76.4%, respectively. Although there was an improvement in the knowledge at 6 weeks’ postintervention, this returned to almost baseline at 16 weeks. The improvement in knowledge did not translate to clinical practice of falls management during this period.ConclusionAlthough educational interventions improve knowledge, the intervention failed to sustain over period of time or translate in clinical practice. Further work is needed to identify alternative methods to improve sustainability of the knowledge of falls and bring in the change in clinical practice.

Download Full-text

Acute Pain Management and Tissue Pain

10.1093/med/9780190217518.003.0016 ◽

2017 ◽

Author(s):

Ignacio Badiola

Keyword(s):

Pain Management ◽

Acute Pain ◽

Pain Treatment ◽

Pain Medicine ◽

Acute Pain Management ◽

Certification Exam ◽

Adults And Children

This chapter on acute pain medicine examines the themes represented on the American Board of Anesthesiology’s pain medicine certification exam. It covers Part 6 (tissue pain), Section 1 (acute pain). In detail, the epidemiology of acute pain, current inadequacy of acute pain therapies, the physiology of acute pain, and both pharmacologic and nonpharmacologic aspects of acute pain treatment are discussed. Tools for assessing acute pain are reviewed, as well as the roles of both patient and family as they relate to adults and children in acute pain.

Download Full-text

Acute and Chronic Pain Learning and Teaching in Medical School—An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students

Medicina ◽

10.3390/medicina55090533 ◽

2019 ◽

Vol 55 (9) ◽

pp. 533 ◽

Cited By ~ 2

Author(s):

Kacper Lechowicz ◽

Igor Karolak ◽

Sylwester Drożdżal ◽

Maciej Żukowski ◽

Aleksandra Szylińska ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Medical Students ◽

Acute Pain ◽

Pain Treatment ◽

Cross Sectional Study ◽

Clinical Group ◽

Sectional Study ◽

Cross Sectional ◽

Actual Knowledge

Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.

Download Full-text

Managing acute pain after abdominal surgery: examples from practice

Journal of Prescribing Practice ◽

10.12968/jprp.2020.2.2.78 ◽

2020 ◽

Vol 2 (2) ◽

pp. 78-83

Author(s):

Nurhayati Nurhayati ◽

Mayoora Madsiri

Keyword(s):

Pain Management ◽

Abdominal Surgery ◽

Acute Pain ◽

Assessment Tool ◽

Pain Treatment ◽

High Incidence ◽

Preoperative Information ◽

Delayed Recovery ◽

Pain At Rest ◽

Adequate Management

Following abdominal surgery, ischaemia and neuropeptide release cause pain at the trauma site, and there is a high incidence of moderate-to-severe pain. Inadequate pain management leads to complications, delayed recovery and prolonged hospitalisation, and thus, effective management is essential. This article describes an implementation of acute pain management after abdominal surgery. A multidimensional assessment tool collected data on demographics, medical history and surgical situation, as well as interventions used, their administration route and their side effects. Pain level was recorded on a scale of 0–10, both at rest and during physical activity, by postoperative day; patient participation and satisfaction were also recorded. Nine patients met the inclusion criteria for the study. Pharmacological analgesic interventions included opioids (morphine, fentanyl and tramadol) and paracetamol. Administration was either intravenous, epidural or via patient-controlled analgesia. These were combined with non-pharmacological interventions, specifically cold gel packs, massage therapy and music therapy. All patients achieved the adequate management goals of pain at rest below 3/10 and during activity below 4/10, and all participated in pain decision-making, were satisfied with pain treatment, and reported the usefulness of preoperative information. Pain management following abdominal surgery is vital, and the use of a combination of pharmacological and non-pharmacological techniques was effective.

Download Full-text

Economic Impact of Adherence to Pain Treatment Guidelines in Chronic Pain Patients

Pain Medicine ◽

10.1093/pm/pnz085 ◽

2019 ◽

Vol 20 (10) ◽

pp. 1907-1918 ◽

Cited By ~ 1

Author(s):

Jay M Margolis ◽

Nicole Princic ◽

David M Smith ◽

Lucy Abraham ◽

Joseph C Cappelleri ◽

...

Keyword(s):

Health Care ◽

Pain Management ◽

Treatment Guidelines ◽

Pain Treatment ◽

Multivariate Statistical ◽

Management Guidelines ◽

Continuous Coverage ◽

Painful Diabetic Peripheral Neuropathy ◽

Before And After ◽

Ed Visits

AbstractObjectivesThis research compared health care resource use (HCRU) and costs for pharmacotherapy prescribing that was adherent vs nonadherent to published pain management guidelines. Conditions included osteoarthritis (OA) and gout (GT) for nociceptive/inflammatory pain, painful diabetic peripheral neuropathy (pDPN) and post-herpetic neuralgia (PHN) for neuropathic pain, and fibromyalgia (FM) for sensory hypersensitivity pain.MethodsThis retrospective cohort study used claims from MarketScan Commercial and Medicare Databases identifying adults newly diagnosed with OA, GT, pDPN, PHN, or FM during July 1, 2006, to June 30, 2013, with 12-month continuous coverage before and after initial (index) diagnosis. Patients were grouped according to their pharmacotherapy pattern as adherent, nonadherent, or “unsure” according to published pain management guidelines using a claims-based algorithm. Adherent and nonadherent populations were compared descriptively and using multivariate statistical analyses for controlling bias.ResultsFinal cohort sizes were 441,465 OA, 76,361 GT, 10,645 pDPN, 4,010 PHN, and 150,321 FM, with adherence to guidelines found in 51.1% of OA, 25% of GT, 59.5% of pDPN, 54.9% of PHN, and 33.5% of FM. Adherent cohorts had significantly (P < 0.05) fewer emergency department (ED) visits and lower proportions with hospitalizations or ED visits. Mean health care costs increased following diagnosis across all conditions; however, adherent cohorts had significantly lower increases in adjusted costs pre-index to postindex (OA $5,286 vs $9,532; GT $3,631 vs $7,873; pDPN $9,578 vs $16,337; PHN $2,975 vs $5,146; FM $2,911 vs $3,708; all P < 0.001; adherent vs nonadherent, respectively).ConclusionsAdherence to pain management guidelines was associated with significantly lower HCRU and costs compared with nonadherence to guidelines.

Download Full-text

The Glycation Products Before and After Therapy for Acute and Chronic Pain

Physiological Research ◽

10.33549/physiolres.933984 ◽

2018 ◽

pp. S685-S688

Author(s):

R. ROKYTA ◽

J. LEJČKO ◽

K. HOUDEK ◽

L. TREFIL ◽

J. NEDVÍDEK ◽

...

Keyword(s):

Chronic Pain ◽

Free Radicals ◽

Surgical Procedures ◽

Acute Pain ◽

Total Protein ◽

Pain Treatment ◽

The Body ◽

Post Operative Pain ◽

Before And After ◽

Treatment Changes

Pain increased the number of free radicals in the body. Previously, we studied changes mainly in oxygen and nitroxide free radicals and described these changes relative to the lipids and saccharides. In this article we focus on changes relative to proteins. Assessment of AGE products (advanced glycation end-products) was carried out by measuring fluorescence. Patients were divided into two groups: 15 patients with acute pain and 17 patients with chronic pain. Acute pain was associated with a variety of surgical procedures and patients were examined before and after surgical procedures. The group of patients with chronic pain suffered from various types of chronic pain, but mainly back pain. In patients with acute pain, total protein (TP) decreased after surgery, as did the level of AGE and the AGE/TP ratio. Nonetheless, post-operative pain increased. In patients with chronic pain, neither total protein, AGE, or AGE/TP changed, despite significant pain relief being reported after treatment. Changes in proteins, as biochemical markers, before and after pain treatment did not show any significant changes. In patients with acute pain, the recorded changes only lasted for 3-5 days after the operation. While in chronic pain, there were no significant changes at all. The assumption that changes in proteins, as biomarkers, would have the same importance as changes in lipids and saccharides was not proven.

Download Full-text

A805 Impact of Clinical Practice Guidelines for Acute Pain Management in New York State

Anesthesiology ◽

10.1097/00000542-199709001-00805 ◽

1997 ◽

Vol 87 (Supplement) ◽

pp. 805A

Author(s):

R.S. Lagasse ◽

E.M. Kitain ◽

M. Jakubowski ◽

K. Ciccone ◽

J. Jiang ◽

...

Keyword(s):

New York ◽

Clinical Practice ◽

Pain Management ◽

Clinical Practice Guidelines ◽

Acute Pain ◽

Practice Guidelines ◽

New York State ◽

Acute Pain Management ◽

York State

Download Full-text

Bringing It All Together: A Review of the Challenges in Measuring Children’s Satisfaction as a Key Component of Acute Pain Management

Children ◽

10.3390/children7110243 ◽

2020 ◽

Vol 7 (11) ◽

pp. 243

Author(s):

Joseph W. Hodapp ◽

Samina Ali ◽

Amy L. Drendel

Keyword(s):

Pain Management ◽

Acute Pain ◽

Pediatric Patients ◽

Consensus Statement ◽

Pain Treatment ◽

Developmentally Appropriate ◽

Future Research ◽

Decision Making Process ◽

Acute Pain Management ◽

Self Evaluation

In 2008, the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) published a consensus statement that recognized the dearth of research surrounding the topic of children’s satisfaction with acute pain management. This review of published literature will summarize what is known about the topic of children’s satisfaction with pain management, identify current gaps in the knowledge, and provide direction for future research in this critical area. Including children in the decision-making process as soon as they are developmentally able is a concept that is the fundamental basis for seeking assent and more active roles within healthcare decisions for children. It is the responsibility of adults to provide them with increasing opportunities for self-evaluation and more independent management of their healthcare, encouraging the development of children into adults. As clinicians and researchers, it is our prerogative to support the maturation of children by building effective methods to communicate their satisfaction with acute pain treatment and healthcare. Children’s satisfaction with acute pain management is not well studied and further research is needed for the development of inclusive, developmentally appropriate measures of satisfaction for our pediatric patients.

Download Full-text