Ridderikhof Milan L, Schyns Frederick J, Schep Niels W, Lirk Philipp, Hollmann Markus W, Goslings J Carel
Department of Emergency Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
J Emerg Med. 2017 Apr;52(4):417-425. doi: 10.1016/j.jemermed.2016.07.015. Epub 2016 Sep 17.
Pain management in the emergency department (ED) remains suboptimal. Nursing staff protocols could improve this, but studies show divergent results.
Our aim was to evaluate a nurse-initiated pain-management protocol in adult patients with traumatic injuries in the short and in the long term, utilizing fentanyl for severe pain.
In this pre-post implementation study, ED patients were included during three periods. The protocol allowed nurses to administer acetaminophen, non-steroidal anti-inflammatory drugs, or fentanyl autonomously, based on Numeric Rating Scale pain scores. Primary outcome was frequency of analgesic administration at 6 and 18 months after implementation. Secondary outcomes were pain awareness, occurrence of adverse events, and pain treatment after discharge.
Five hundred and twelve patients before implementation were compared with 507 and 468 patients at 6 and 18 months after implementation, respectively. Analgesic administration increased significantly at 18 months (from 29% to 36%; p = 0.016), not at 6 months (33%; p = 0.19) after implementation. Pain awareness increased from 30% to 51% (p = 0.00) at 6 months and to 56% (p = 0.00) at 18 months, due to a significant increase in pain assessment: 3% to 30% (p = 0.00) and 32% (p = 0.00), respectively. Post-discharge pain treatment increased significantly at 18 months compared to baseline (from 25% to 33%; p = 0.016) and to 6 months (from 24% to 33%; p = 0.004). No adverse events were recorded.
Implementation of a nurse-initiated pain-management protocol only increases analgesic administration in adult patients with traumatic injuries in the long term. Auditing might have promoted adherence. Pain awareness increases significantly in the short and the long term.
急诊科的疼痛管理仍未达到最佳状态。护理人员协议可能会改善这种情况，但研究结果不一。
我们的目的是评估一项由护士发起的针对成年创伤患者的疼痛管理协议在短期和长期的效果，使用芬太尼治疗重度疼痛。
在这项实施前后的研究中，急诊科患者在三个时期被纳入。该协议允许护士根据数字评分量表的疼痛评分自主给予对乙酰氨基酚、非甾体抗炎药或芬太尼。主要结局是实施后6个月和18个月时镇痛药物的使用频率。次要结局包括疼痛知晓度、不良事件的发生情况以及出院后的疼痛治疗。
实施前的512例患者分别与实施后6个月的507例患者和18个月的468例患者进行比较。实施后18个月时镇痛药物的使用显著增加（从29%增至36%；p = 0.016），而6个月时未增加（33%；p = 0.19）。由于疼痛评估显著增加，疼痛知晓度在6个月时从30%增至51%（p = 0.00），在18个月时增至56%（p = 0.00），疼痛评估分别从3%增至30%（p = 0.00）和32%（p = 0.00）。与基线相比，出院后疼痛治疗在18个月时显著增加（从25%增至33%；p = 0.016），与6个月时相比也增加（从24%增至33%；p = 0.004）。未记录到不良事件。
由护士发起的疼痛管理协议的实施仅在长期内增加了成年创伤患者的镇痛药物使用。审核可能促进了依从性。疼痛知晓度在短期和长期均显著提高。
