Shaban Ramon Z, Holzhauser Kerri, Gillespie Kerri, Huckson Sue, Bennetts Scott
Griffith Health Institute, Research Centre for Clinical and Community Practice Innovation, Griffith University, Australia.
Australas Emerg Nurs J. 2012 Feb;15(1):23-30. doi: 10.1016/j.aenj.2011.11.003. Epub 2012 Jan 21.
It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management.
A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken.
Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients' pain level and attitudes toward pain assessment and pain management were identified as barriers.
This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED.
众所周知，疼痛是急诊科最常见的就诊主诉。尽管现有疼痛管理策略有了很大改进，但患者在抵达急诊科后仍需等待60分钟以上才能缓解疼痛。本研究的目的是描述有助于成功实施澳大利亚国家卫生与医学研究委员会批准的指南《急性疼痛管理：科学证据》（第二版）的干预措施，该指南包含最佳实践疼痛管理的具体建议。
对参与国家急诊护理疼痛管理倡议的所有52家澳大利亚医院急诊科进行了一项两阶段、混合方法的探索性研究，采用了访谈和文件分析。
临床医生用于改善疼痛管理的干预措施包括护士启动的镇痛、小儿患者使用鼻内芬太尼和利多卡因以及髂腹股沟神经阻滞。教育是干预措施的主要组成部分，关键利益相关者工作小组的组建对于成功实施变革至关重要。工作人员对患者疼痛程度的认知以及对疼痛评估和疼痛管理的态度被确定为障碍。
本研究强调了一个有效的框架如何规划和实施实践变革以及量身定制的干预措施，包括利用现有最佳证据的教育和培训系统及产品，使临床医生能够在急诊科更好地管理疼痛。
