None listed
Conditions
Brief summary
We know very little about how ED clinicians adjust care practices to accommodate for the needs of cognitively impaired older Australian experiencing acute pain. Given the front line positioning of emergency services, emergency department nurses are well placed to become active leaders and innovatively responsive in reducing human suffering. Pain, is costly both in human suffering and lost productivity. Therefore, ensuring timely pain assessment and appropriate analgesic interventions for older people with cognitive impairment is critical. International studies have demonstrated the benefits of the Pain in Advanced Dementia Screening Tool (PAINAD), but no study has taken place in Australasian EDs. This research proposes to explore pain management in older (>64years) Australians with suspected long bone fractures and to randomise the use of the validated pain assessment tool (PAINAD tool) for patients with cognitive impairment. The aim of the study is to conduct a cluster randomised controlled trial of the PAINAD screening tool for cognitively impaired older people (>64years) presenting to emergency departments with suspected long bone fracture and compare results to standard treatment.
Interventions
There is no nationally accepted tool, in emergency departments, for assessing pain in patients with cognitive impairment. Current Australasian practice is for emergency nurses to assess a patient’s pain using the verbal analogue scales (0-10 pain scale score). However, a verbal analogue scale does not meet the needs of the older person with cognitive impairment and or communication barriers. Given the lack of an appropriate screening tool, pain assessment and timely analgesic intervention is
There is no nationally accepted tool, in emergency departments, for assessing pain in patients with cognitive impairment. Current Australasian practice is for emergency nurses to assess a patient’s pain using the verbal analogue scales (0-10 pain scale score). However, a verbal analogue scale does not meet the needs of the older person with cognitive impairment and or communication barriers. Given the lack of an appropriate screening tool, pain assessment and timely analgesic intervention is made more difficult for older persons with cognitive impairment. The Pain Assessment in Advanced Dementia (PAINAD) screening tool has features that most closely resemble an ‘ideal’ tool for ED clinicians for pain assessment of cognitively impaired patients. PAINAD comprises five behavioural categories: breathing, vocalization, facial expression, body language and consolability. The PAINAD tool uses a ten point score scale which is assigned by the clincian as a result of responses given by the patient. PAINAD is similar to the verbal analogue scale (0-10 scale) emergency clinicians currently use for pain assessment. Furthermore, in a time poor environment such as the ED the PAINAD tool is quick, relatively simple to use and allows for measuring pain assessment trends over time. Our randomised blinded prospective study will be conducted in four emergency departments: two departments were randomized to use the Pain Assessment in Advanced Dementia (PAINAD) tool and two departments to continue standard care using the verbal analogue scale. A convenience sample of patients with suspected long bone fracture in the control sites (two) will be examined for cognitive impairment using the SIS cognitive screening tool and continue to routinely be assessed for pain using current pain assessment scales (verbal analogue scale). In the intervention sites (two) a convenience sample of patients with suspected long bone fracture will be screened for cognitive impairment using the SIS and if the score is less than four (cognitive impairment), patients will be screened for pain using the PAINAD tool.
Sponsors
Research and Practice Development Unit, Northern Sydney Local Health District
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
People over 64 years of age who present to the Emergency Department with suspected long bone fracture.
Exclusion criteria
Triage Category 1, multi-trauma and haemodynamic or respiratory instability.
Outcome results
None listed