Pierik Jorien G J, Berben Sivera A, IJzerman Maarten J, Gaakeer Menno I, van Eenennaam Fred L, van Vugt Arie B, Doggen Carine J M
Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Drienerlolaan 5, P.O. Box 217, 7522 NB, Enschede, Netherlands.
Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Health and Social Studies, Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, Netherlands.
Int Emerg Nurs. 2016 Jul;27:3-10. doi: 10.1016/j.ienj.2016.02.001. Epub 2016 Mar 8.
While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre- (15 months, n = 504) and post-period (6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain (NRS ≥4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min (P < 0.05), whereas time to opioids decreased from 37 to 15 min (P < 0.01). Mean pain relief significantly increased to 1.56 NRS-points, in patients who received analgesic treatment even up to 2.02 points. The protocol appeared to lead to an increase in analgesic administration, shorter time to analgesics and a higher clinically relevant pain relief. Despite improvements, suffering moderate to severe pain at ED discharge was still common. Protocol adherence needs to be studied in order to optimize pain management.
虽然急性肌肉骨骼疼痛是一种常见的主诉，但对其管理往往被忽视。在急诊科实施基于荷兰疼痛管理指南算法的护士主导疼痛方案可能会改善这种情况。作为前瞻性PROTACT随访研究的一部分，进行了一项干预前后研究。在干预前（15个月，n = 504）和干预后（6个月，n = 156）期间，记录患者自我报告的疼痛强度和疼痛治疗情况。中度至重度疼痛（数字评分量表≥4）患者的镇痛药物使用从46.8%提高到68.0%。超过10%的患者拒绝使用镇痛药，导致实际镇痛药物使用率从36.3%提高到46.1%。镇痛药物给药的中位时间从10分钟降至7分钟（P < 0.05），而使用阿片类药物的时间从37分钟降至15分钟（P < 0.01）。接受镇痛治疗的患者平均疼痛缓解显著增加至1.56个数字评分量表点，甚至高达2.02点。该方案似乎导致了镇痛药物使用增加、镇痛药物给药时间缩短以及更高的临床相关疼痛缓解。尽管有所改善，但在急诊科出院时仍有中度至重度疼痛的情况很常见。需要研究方案的依从性以优化疼痛管理。
