Development and Implementation of an Emergency Department Protocol for Pain Management at Triage

2.50
Hdl Handle:
http://hdl.handle.net/10755/162873
Type:
Presentation
Title:
Development and Implementation of an Emergency Department Protocol for Pain Management at Triage
Abstract:
Development and Implementation of an Emergency Department Protocol for Pain Management at Triage
Conference Sponsor:Emergency Nurses Association
Conference Year:2003
Author:Krett-Dougherty, Karen, RN, CEN, SANE-A
P.I. Institution Name:Christiana Care Health System, RNII, ED
Contact Address:4755 Stanton-Ogletown Road, Newark, DE, 19718, USA
Contact Telephone:302/475-5504
Co-Authors:Karen Rollo, RN, BSN, SANE; Meriam Dennie, RN, MS, CEN, SANE, PHRN, NRMET-B; Patricia Campbell, RN, BSN, MICN; and Oksana Iwakiw, RN, BSN, MICN
Clinical Topic: Pain is the primary chief complaint when patients seek emergency care. Also, with frequent emergency department overcrowding, patients often have to wait for a long time before receiving definitive care. The project was developed in an effort to provide early pain relief at triage and to reduce patient complaints about long waiting time. The pain protocol serves both the adult and pediatric populations. Implementation: Planning and implementation included the following steps: 1) Development of a committee and a proposal for a pain protocol. 2) Creation of criteria and standing orders for treatment of pain. 3) Establishment of safety measures for the storage of narcotics at triage. Patients with no relief from Ibuprofen or Tylenol, Percocet is administered. If patient is allergic or vomiting the physician is contacted for an alternative analgesic. 4) Pain assessment using two measurable tools, one for pediatric and one for adult patients. A visual analog scale (VAS) using a 1-10 scale is used for adults. The Wong-Baker faces pain rating scale, utilizing facial expression is used for the pediatric population. 5) Obtain physician and nursing administrative approval. 6) Education of all RN and physician staff prior to implementation. Outcomes: Evaluation demonstrated improved patient satisfaction scores on the Press Ganey customer satisfaction surveys. 1) Patient pain was treated earlier and in a more consistent, objective manner. 2) Increased patient comfort resulted in fewer patient complaints regarding long waits during periods of overcrowding. There appears to be a correlation trending towards a decrease length of stay (LOS) and increased patient satisfaction. There are no definitive percentages available. Quarterly Press Ganey scores are reflective of increased patient satisfaction. 3) Nursing staff was empowered to provide prompt treatment of patients' pain. 4) Assessment, treatment, and evaluation of patients' pain have now become an expectation of the triage staff. Recommendations: Recommendations for the future include incorporating the pain protocol into the emergency department orientation manual. Christiana emergency department is a Level 1 Trauma Center seeing approximately 90,000 visits yearly. The successful use of a pain protocol in an emergency department this size suggests that such a protocol would be relevant and applicable in other institutions of similar size and patient volume. Recommendations have also been made to evaluate the percentage of patients who leave against medical advice (AMA) after receiving pain medication at triage. [Clinical Poster]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDevelopment and Implementation of an Emergency Department Protocol for Pain Management at Triageen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162873-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Development and Implementation of an Emergency Department Protocol for Pain Management at Triage</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2003</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Krett-Dougherty, Karen, RN, CEN, SANE-A</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Christiana Care Health System, RNII, ED</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">4755 Stanton-Ogletown Road, Newark, DE, 19718, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">302/475-5504</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kdoc@comcast.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Karen Rollo, RN, BSN, SANE; Meriam Dennie, RN, MS, CEN, SANE, PHRN, NRMET-B; Patricia Campbell, RN, BSN, MICN; and Oksana Iwakiw, RN, BSN, MICN</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Pain is the primary chief complaint when patients seek emergency care. Also, with frequent emergency department overcrowding, patients often have to wait for a long time before receiving definitive care. The project was developed in an effort to provide early pain relief at triage and to reduce patient complaints about long waiting time. The pain protocol serves both the adult and pediatric populations. Implementation: Planning and implementation included the following steps: 1) Development of a committee and a proposal for a pain protocol. 2) Creation of criteria and standing orders for treatment of pain. 3) Establishment of safety measures for the storage of narcotics at triage. Patients with no relief from Ibuprofen or Tylenol, Percocet is administered. If patient is allergic or vomiting the physician is contacted for an alternative analgesic. 4) Pain assessment using two measurable tools, one for pediatric and one for adult patients. A visual analog scale (VAS) using a 1-10 scale is used for adults. The Wong-Baker faces pain rating scale, utilizing facial expression is used for the pediatric population. 5) Obtain physician and nursing administrative approval. 6) Education of all RN and physician staff prior to implementation. Outcomes: Evaluation demonstrated improved patient satisfaction scores on the Press Ganey customer satisfaction surveys. 1) Patient pain was treated earlier and in a more consistent, objective manner. 2) Increased patient comfort resulted in fewer patient complaints regarding long waits during periods of overcrowding. There appears to be a correlation trending towards a decrease length of stay (LOS) and increased patient satisfaction. There are no definitive percentages available. Quarterly Press Ganey scores are reflective of increased patient satisfaction. 3) Nursing staff was empowered to provide prompt treatment of patients' pain. 4) Assessment, treatment, and evaluation of patients' pain have now become an expectation of the triage staff. Recommendations: Recommendations for the future include incorporating the pain protocol into the emergency department orientation manual. Christiana emergency department is a Level 1 Trauma Center seeing approximately 90,000 visits yearly. The successful use of a pain protocol in an emergency department this size suggests that such a protocol would be relevant and applicable in other institutions of similar size and patient volume. Recommendations have also been made to evaluate the percentage of patients who leave against medical advice (AMA) after receiving pain medication at triage. [Clinical Poster]</td></tr></table>en_GB
dc.date.available2011-10-27T10:35:36Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:35:36Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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