None listed
Conditions
Brief summary
This research project aims to enhance our understanding of the association between acute pain management in the emergency department (ED) and hospital acquired complications in older adults (aged 65 years and over). Acute pain is the most common primary complaint for patients presenting to the ED. Despite previous efforts made to improve the quality of acute pain management, recent publications continue to show pain under-treatment remains prevalent, especially among elderly patients. We will be introducing the ED-exit pain score supported by staff education to evaluate its impact on our current acute pain treatment regimen and its feasibility in clinical practice. Outcomes including types and total amount of pain modalities used, the incidence of delirium and other hospital acquired complications specific to older patient population will be collected during the pre- and post-intervention periods. The project findings will fill knowledge gaps in the field and present a strategy that can be easily incorporated in EDs across NSW.
Interventions
This research project introduces the ED-exit pain assessment. An ED Patient Safe Transfer Checklist already exists on FirstNet and this document needs to be completed prior to inpatient ward transfer or ED discharge. The checklist currently contains a section that allows clinicians to answer if the patient still remains in pain or not before their physical ED departure. FirstNet is an electronic medical records (eMR) portal used by New South Wales (NSW) Health to support various operations in ED
This research project introduces the ED-exit pain assessment. An ED Patient Safe Transfer Checklist already exists on FirstNet and this document needs to be completed prior to inpatient ward transfer or ED discharge. The checklist currently contains a section that allows clinicians to answer if the patient still remains in pain or not before their physical ED departure. FirstNet is an electronic medical records (eMR) portal used by New South Wales (NSW) Health to support various operations in EDs across the state. We will liaise with the local eMR team to mandate the ED-exit pain score and create an additional interface that allows clinicians to use appropriate pain scales based on background medical conditions (i.e. dementia) of individual patients once they have been identified to be in pain using the same form. The ED-exit pain assessment is anticipated not to take more than a few minutes (maximum of 3 minutes). The implementation of the ED-exit pain score will be supported by regular staff education, which is planned to be delivered over a period of 1 month to increase general awareness of the checklist. These short education sessions of approximately 10-minute in duration will be conducted by experienced medical and nursing staff through usual professional development channels. These sessions will typically be held in group setting three times weekly before the beginning of morning clinical shift during the compulsory staff briefing in attempt to capture as many nursing staff as possible. The ED-exit pain assessment will also be introduced during trainee teaching that is held on a weekly basis for medical staff. We predict a high compliance rate of the checklist once it becomes obligatory in routine clinical care not only in those older adults, but to all patients irrespective of their age. The compliance of the modified form will be monitored by regular checks using the eMR.
Sponsors
Royal North Shore Hospital Emergency Department
Study design
Allocation
Non-randomised trial
Primary purpose
Diagnosis
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Patients aged greater than or equal to 65 years presenting with pain (sources all inclusive – abdominal, musculoskeletal, non-cardiac chest pain) • Not requiring operative intervention • If admitted to the hospital, minimum LOS greater than or equal to 48 hours
Exclusion criteria
• Patients under the age of 65 years • Headache, cardiac chest pain • Hospital LOS less than or equal to 48 hours • Medically unstable patients requiring admission to intensive or palliative care units • Concurrent ED presentation with delirium (hypo- and/or hyperactive) • History of psychiatric disorders • History of chronic pain on long-term (greater than or equal to 3 months) use of opioid analgesics
Outcome results
None listed