Documentation of Patient Pain in the Emergency Department and the Impact of a Nursing Documentation Inservice

2.50
Hdl Handle:
http://hdl.handle.net/10755/162965
Type:
Presentation
Title:
Documentation of Patient Pain in the Emergency Department and the Impact of a Nursing Documentation Inservice
Abstract:
Documentation of Patient Pain in the Emergency Department and the Impact of a Nursing Documentation Inservice
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Bernhardt, Christina A., RN, MS, CNS
P.I. Institution Name:Parker Adventist Hospital
Title:Clinical Nurse Specialist of Acute Care
Contact Address:9395 Crown Crest Blvd., Parker, CO, 80138, USA
Contact Telephone:(303) 269-4658
Co-Authors:Chad E. Roline, BA; Carol C. deBaca, BS; Jason S. Haukoos, MD, MS
Purpose: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) states that pain continues to be under-medicated. JCAHO requires institutions to implement protocols for assessing and managing pain. The purpose of this study was to assess patient pain documentation in emergency department (ED) patients who received narcotics before and after an ED inservice on pain documentation. Design: This was a retrospective cohort study. Setting: The study was conducted at an urban Level I Trauma Center. Sample: Medical records of 300 adult patients who received enteral or parenteral narcotics in the emergency department were evaluated. Methodology: The 300 records were examined for documentation of pain assessment before and after administration of narcotics. This study was divided into three periods containing 100 patients each. The first period included patients treated before the departmental pain documentation inservice presented to ED staff in May 2002. The second period included patients treated after the inservice. The third period included patients treated two years later, in May 2004. A closed-response data collection instrument was used to collect patient demographics, baseline vital signs, type of narcotics received, person who recorded the information (i.e., nurse or physician), and presence of a qualitative pain assessment or a quantitative pain score before and after narcotics were administered. The chi-square test was used to assess statistical differences in proportions between the three study groups. Results: Prior to the inservice training, 64% (95% CI: 54% - 73%) of records completed by nurses included pain documentation (either qualitative or quantitative) and 9% (95% CI: 4% -16%) of physician records included pain documentation. Following the inservice, presence of pain documentation in nurse and physician records was 55% (95% CI: 45% - 65%) and 20% (95% CI: 13% - 29%), respectively. At the two-year follow-up, pain documentation was 56% (95% CI: 46% - 66%) for nurses and 17% (95% CI: 10% - 26%) for physicians. Inter-rater reliability between the two data collectors was nearly perfect (average kappa = 0.90) across all groups. Conclusions: The level of documentation of patient pain assessment in the emergency department before and after the administration of enteral or parenteral narcotics remains low. Additionally, we have shown that a brief departmental inservice on the evaluation, management, and documentation of pain in patients who present to the emergency department is an ineffective method of increasing pain documentation levels even in the short-term. Further research is needed to develop and evaluate effective methods for improving nurse and physician documentation of patient pain in the emergency department.
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.titleDocumentation of Patient Pain in the Emergency Department and the Impact of a Nursing Documentation Inserviceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162965-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Documentation of Patient Pain in the Emergency Department and the Impact of a Nursing Documentation Inservice</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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Bernhardt, Christina A., RN, MS, CNS</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Parker Adventist Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist of Acute Care</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9395 Crown Crest Blvd., Parker, CO, 80138, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(303) 269-4658</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">christina.bernhardt@comcast.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Chad E. Roline, BA; Carol C. deBaca, BS; Jason S. Haukoos, MD, MS</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) states that pain continues to be under-medicated. JCAHO requires institutions to implement protocols for assessing and managing pain. The purpose of this study was to assess patient pain documentation in emergency department (ED) patients who received narcotics before and after an ED inservice on pain documentation. Design: This was a retrospective cohort study. Setting: The study was conducted at an urban Level I Trauma Center. Sample: Medical records of 300 adult patients who received enteral or parenteral narcotics in the emergency department were evaluated. Methodology: The 300 records were examined for documentation of pain assessment before and after administration of narcotics. This study was divided into three periods containing 100 patients each. The first period included patients treated before the departmental pain documentation inservice presented to ED staff in May 2002. The second period included patients treated after the inservice. The third period included patients treated two years later, in May 2004. A closed-response data collection instrument was used to collect patient demographics, baseline vital signs, type of narcotics received, person who recorded the information (i.e., nurse or physician), and presence of a qualitative pain assessment or a quantitative pain score before and after narcotics were administered. The chi-square test was used to assess statistical differences in proportions between the three study groups. Results: Prior to the inservice training, 64% (95% CI: 54% - 73%) of records completed by nurses included pain documentation (either qualitative or quantitative) and 9% (95% CI: 4% -16%) of physician records included pain documentation. Following the inservice, presence of pain documentation in nurse and physician records was 55% (95% CI: 45% - 65%) and 20% (95% CI: 13% - 29%), respectively. At the two-year follow-up, pain documentation was 56% (95% CI: 46% - 66%) for nurses and 17% (95% CI: 10% - 26%) for physicians. Inter-rater reliability between the two data collectors was nearly perfect (average kappa = 0.90) across all groups. Conclusions: The level of documentation of patient pain assessment in the emergency department before and after the administration of enteral or parenteral narcotics remains low. Additionally, we have shown that a brief departmental inservice on the evaluation, management, and documentation of pain in patients who present to the emergency department is an ineffective method of increasing pain documentation levels even in the short-term. Further research is needed to develop and evaluate effective methods for improving nurse and physician documentation of patient pain in the emergency department.</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:13Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:13Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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