Two hundred days of nurse practitioner prescribing and role development: a case study report from a hospital-based acute pain management team

Purpose. This report evaluates a beginning Nurse Practitioner (NP) role in Acute Pain Management. Healthcare setting. The role was implemented within an anaesthesiology-based pain service. The NP author developed this pain service in 2002 and was endorsed as an NP 6 years later. The NP reviews all clients undergoing major surgery or trauma and provides pain management to women for caesarean section. Prior to this role, there were significant delays for some patients requiring prompt analgesia. This was because of the decreased availability of anaesthetists to fully participate in the pain service due to the demand for complex anaesthesiology practice. Method of data collection. Data were conveniently collected by the NP on prescription and service provision over 200 working days. Main findings. Therapeutic activity reflected contemporary pain management practice and espouse the NP as a safe and effective clinician. The role has improved patient access to pain management through the prompt use of non-pharmacological interventions, drugs used to treat analgesic side effects, opioids and non-opioid analgesics. Principal conclusions. These initial positive outcomes are consistent with NP role development described elsewhere in Australia and overseas across a variety of healthcare settings. To sustain this role, robust continuing education and clinical support is required. What is known about the topic? There is little published information on the development of the Nurse Practitioner (NP) role in acute pain services in Australia or overseas. The acute pain role is a new development in Australia and so previous descriptions of NP practice have focussed on other specialty areas such as Emergency or Mental Health. What does this paper add? This report demonstrates positive and safe client outcomes as a result of a NP role in acute pain management. More importantly, it may contribute to accumulating evidence that NPs are safe prescribers of opioids and other analgesics in acute settings. What are the implications for practitioners? Novice NPs and Candidates practising in this specialty need to use this information as support for their own role development and implementation in other acute pain services in Australia.

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Oral and Parenteral Opioid Analgesics for Acute Pain Management

Acute Pain Management ◽

10.1017/cbo9780511576706.015 ◽

2009 ◽

pp. 188-203 ◽

Cited By ~ 1

Author(s):

Raymond S. Sinatra ◽

Henry McQuay

Keyword(s):

Pain Management ◽

Acute Pain ◽

Opioid Analgesics ◽

Acute Pain Management

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Acute pain management in principle

10.1093/med/9780199234721.003.0004 ◽

2011 ◽

Author(s):

Jeremy N. Cashman

Keyword(s):

Clinical Practice ◽

Pain Management ◽

Clinical Practice Guidelines ◽

Acute Pain ◽

Practice Guidelines ◽

Oral Route ◽

Acute Pain Management ◽

Post Operative Pain ◽

Pain Services

Pain measurement is essential in evaluating response to analgesic therapy. The oral route is the route of choice for analgesics in non-fasting patients. Administering opioids by the neuraxial route provides superior analgesia to the same drug administered by parenteral routes. Clinical practice guidelines may be useful in acute pain management. Acute Pain Services improve the quality of post-operative pain management.

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Factors influencing hospital implementation of acute pain management practice guidelines

Journal of Clinical Anesthesia ◽

10.1016/s0952-8180(01)00268-9 ◽

2001 ◽

Vol 13 (4) ◽

pp. 268-276 ◽

Cited By ~ 27

Author(s):

H.Joanna Jiang ◽

Robert S Lagasse ◽

Kathleen Ciccone ◽

Michael S Jakubowski ◽

Eric M Kitain

Keyword(s):

Pain Management ◽

Acute Pain ◽

Practice Guidelines ◽

Management Practice ◽

Acute Pain Management ◽

Factors Influencing

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Meeting Proceedings: Recommendations for Improved Acute Pain Services: Canadian Collaborative Acute Pain Initiative

Pain Research and Management ◽

10.1155/2004/397452 ◽

2004 ◽

Vol 9 (3) ◽

pp. 123-130 ◽

Cited By ~ 13

Author(s):

David H Goldstein ◽

Jacqueline Ellis ◽

Robert Brown ◽

Rosemary Wilson ◽

John Penning ◽

...

Keyword(s):

Pain Management ◽

Acute Pain ◽

Health Professionals ◽

Symptom Management ◽

Therapeutic Options ◽

Management Service ◽

Acute Pain Management ◽

Definition Of ◽

Pain Services

The Canadian Collaborative Acute Pain Initiative, established in 2002, is a voluntary, multidisciplinary consortium of acute pain health professionals from across Canada whose goal is to improve acute pain management through discussion and consensus. The group met in January 2002 to define strategic areas related to the treatment of acute pain. The areas identified were: the definition of pain; the epidemiology of pain; the concept of an 'ideal' acute pain management service; education; therapeutic options; symptom management; and research and safety. In November 2002, a second meeting was held to develop objectives and recommendations for the management of acute pain based on the defined areas. The outcome of these discussions is summarized in this paper.

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(A72) Efficacy of Parental Opioid Analgesics versus Non-Opioid Analgesic in Acute Pain Management of Trauma Victims in the Emergency Department

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11000793 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s20-s20

Author(s):

G. Adhikari ◽

S. Bhoi ◽

P. Gautam ◽

T.P. Sinha ◽

M. Rodha ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Acute Pain ◽

Opioid Analgesic ◽

Opioid Analgesics ◽

Acute Pain Management ◽

Vas Score ◽

Group A ◽

Trauma Victims ◽

Group B

BackgroundThe pyramid of pain management involves sequential drug escalation but its role is limited in an emergency department (ED). The efficacy of parental opioid analgesics versus non-opioid analgesic in acute pain management of trauma victims in the ED was evaluated to formulate protocol.MethodsAll alert patients with a baseline visual analogue scale score (≥ 7) was randomly assigned either parental non-opioid (Group A) or opioid analgesics (Group B). The emergency care providers noted the VAS in either group at 15 minutes, 30 minutes, and 60 minutes, and at the time of discharge from the ED. If the patient's VAS score did not reduce by 50% at 30 minutes, repeat parental analgesics was given. The oral analgesics prescribed at the time of discharge were documented. Ethical clearance was taken. Data was compiled and analyzed.ResultsOf 106 patients, 99 were analyzed. The mean age in Group A was 33.2 ± 13.2 years and 32.5 ± 18 years in Group B. The male:female ratio in Group A was 1.5:1 and 7:1 in Group B. The average baseline VAS score in Group A was 7.5, and that of Group B was 8.96. The average VAS at 15, 30, and 60 minutes and at discharge in Group A was 5.4, 5.34, 4.3, and 3.5 and it was 6.1, 6, 5.1, and 4.4. Repeat parental dose of analgesics were required in 95/99 (95%) patients in Group A and 5% that of Group B. The most common prescription at discharge from ED was non-opioid analgesics.ConclusionsAcute pain relief was comparable in both groups. Non-opioid analgesics may be preferred over opioid in VAS score ± 7 in a busy emergency department for early disposition.

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Acute Pain Management: Operative or Medical Procedures and Trauma

Annals of Pharmacotherapy ◽

10.1177/106002809703100917 ◽

1997 ◽

Vol 31 (9) ◽

pp. 1068-1076 ◽

Cited By ~ 35

Author(s):

Sheryl L Follin ◽

Scott L Charland

Keyword(s):

Clinical Practice ◽

Pain Management ◽

Acute Pain ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Pain Assessment ◽

Opioid Analgesics ◽

Data Sources ◽

Medical Procedures ◽

Acute Pain Management

Objective To review the topics presented in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for Acute Pain Management and provide updated information on therapeutic issues as necessary. Data Sources AHCPR Clinical Practice Guideline for Acute Pain Management: Operative or Medical Procedures and Trauma. A MEDLINE search (1990 to June 1996) of English-language literature pertaining to pain assessment and management was performed. Reference lists from relevant articles also served as a literature source. Study Selection and Data Extraction All articles identified from the data sources were evaluated. Relevant information, as determined by the authors, was included in the review. Data Synthesis Inadequate acute pain management continues to be recognized as a problem due to limited health professional education on the treatment of pain, inadequate patient empowerment, negative connotations associated with opioid analgesics (e.g., fear of “addiction”), federal regulations associated with prescribing opioid analgesics, and difficulty in assessing pain. The widespread inadequacy in pain management prompted the development of the AHCPR Clinical Practice Guideline for Acute Pain Management, which was published in 1992. In addition to reviewing the pain guideline, this article includes updated information on ketorolac tromethamine, tramadol, local anesthetics, sedation, regional anesthetic techniques, and the management of opioid adverse effects. Conclusions The AHCPR Clinical Practice Guideline for Acute Pain Management is a comprehensive, yet functional, review for clinicians. Most issues relating to acute pain assessment and management are adequately discussed. Overall, this guideline is a worthwhile general resource to clinicians. It is important, however, for clinicians managing acute pain issues to supplement this guideline with more detailed and current information.

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