Decosterd Isabelle, Hugli Olivier, Tamchès Emmanuel, Blanc Catherine, Mouhsine Elyazid, Givel Jean-Claude, Yersin Bertrand, Buclin Thierry
Department of Anesthesiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
Ann Emerg Med. 2007 Oct;50(4):462-71. doi: 10.1016/j.annemergmed.2007.01.019. Epub 2007 Apr 18.
Acute pain is the most frequent complaint in emergency department (ED) admissions, but its management is often neglected, placing patients at risk of oligoanalgesia. We evaluate the effect of the implementation of guidelines for pain management in ED patients with pain at admission or anytime during their stay in our ED.
This prospective pre-post intervention cohort study included data collection both before and after guideline implementation. Consecutive adult patients admitted with acute pain from any cause or with pain at any time after admission were enrolled. The quality of pain management was evaluated according to information in the ED medical records by using a standardized collection form, and its impact on patients was recorded with a questionnaire at discharge.
Two hundred forty-nine and 192 patients were included during pre- and postintervention periods. Pain was documented in 61% and 76% of nurse and physician notes, respectively, versus 78% and 85% after the intervention (difference 17%/9%; 95% confidence interval [CI] 8% to 26%/2% to 17%, respectively). Administration of analgesia increased from 40% to 63% (difference 23%; 95% CI 13% to 32%) and of morphine from 10% to 27% (difference 17%; 95% CI 10% to 24%). Mean doses of intravenous morphine increased from 2.4 mg (95% CI 1.9 to 2.9 mg) to 4.6 mg (95% CI 3.9 to 5.3 mg); administration of nonsteroidal antiinflammatory drugs and acetaminophen increased as well. There was a greater reduction of visual analogue scale score after intervention: 2.1 cm (95% CI 1.7 to 2.4 cm) versus 2.9 cm (95% CI 2.5 to 3.3 cm), which was associated with improved patient satisfaction.
Education program and guidelines implementation for pain management lead to improved pain management, analgesia, and patient satisfaction in the ED.
急性疼痛是急诊科收治患者最常见的主诉，但疼痛管理常常被忽视，使患者面临镇痛不足的风险。我们评估了在急诊科对入院时或留观期间任何时间存在疼痛的患者实施疼痛管理指南的效果。
这项前瞻性干预前后队列研究包括在指南实施前后收集数据。纳入因任何原因入院时伴有急性疼痛或入院后任何时间出现疼痛的成年连续患者。根据急诊科病历中的信息，使用标准化收集表评估疼痛管理质量，并在出院时通过问卷记录其对患者的影响。
干预前和干预后分别纳入249例和192例患者。护士和医生记录中分别有61%和76%记录了疼痛，而干预后这一比例为78%和85%（差异分别为17%/9%；95%置信区间[CI]分别为8%至26%/2%至17%）。镇痛药物的使用从40%增加到63%（差异23%；95%CI为13%至32%），吗啡的使用从10%增加到27%（差异17%；95%CI为10%至24%）。静脉注射吗啡的平均剂量从2.4mg（95%CI为1.9至2.9mg）增加到4.6mg（95%CI为3.9至5.3mg）；非甾体类抗炎药和对乙酰氨基酚的使用也有所增加。干预后视觉模拟量表评分的降低幅度更大：2.1cm（95%CI为1.7至2.4cm）对比2.9cm（95%CI为2.5至3.3cm），这与患者满意度提高相关。
疼痛管理的教育项目和指南实施可改善急诊科的疼痛管理、镇痛效果及患者满意度。
