Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain

Abstract

Introduction

Pain is a common symptom presented in the emergency department (ED) although it is often underestimated, poorly evaluated and treated. The application of a protocol for timely pain management ensured by the nurse can avoid the delays in the analgesic treatment and improve the patient’s quality of waiting.

Aims

To check the effectiveness and efficiency of the protocol aimed at early pain management in triage, active in our ED. In particular, the response to analgesic treatment was evaluated 60 minutes after the administration and at discharge. Patient satisfaction was also evaluated using two anonymous questionnaires both at discharge and 48 hours later via telephone.

Methods

A single-center, observational study was conducted on a prospective cohort of patients (aged ≥4 years) with a pain symptom at admission in ED with no surgical picture.

Results

In the observation period (June 2015–May 2016), 382 patients were enrolled, and of these, 312 (84.8%) accepted pain therapy during triage stage in the ED. In 97.4% of the cases, orosoluble paracetamol 1000 mg was administered. In the re-evaluation done 60 minutes later, 65.9% of the patients showed a reduction of at least 2 points on Numeric Rating Scale (NRS), equal to a mean reduction of 2.24 points (95% CI: 2.03–2.45). The mean time of analgesia intake was equal to 5.9 minutes (95% CI: 3.8–8.1). In the re-evaluation done at discharge, 33.2% of the patients showed a reduction of NRS score >50%, leading to a mean reduction of 39% (95% CI: 35.3%−41.9%). The level of patient satisfaction was high with a mean value >9 points (maximum satisfaction =10).

Conclusion

This protocol shows that optimal pain management was achieved by patients rapidly receiving an effective painkiller therapy at triage, leading to substantial patient satisfaction. In moderate pain, orosoluble paracetamol 1000 mg provided a reduction of NRS score by 2 points in 67.6% of the patients, confirming to be the analgesic of choice in ED.

Keywords:

• pain management
• protocol
• triage
• analgesic
• orosoluble paracetamol

Supplementary materials

Table S1 Satisfaction degree

Table S2 Time after receipt of analgesic at discharge for each diagnosis

Acknowledgments

We thank all the nurses of S.O.C. Pronto Soccorso Medicina d’Urgenza (Emergency Department), for their valuable contribution to the data collection. The results presented in this paper have not been published previously in whole or in part and are not under submission elsewhere. This submission represents an original work and all authors have read and approved the submission of this manuscript. The authors have no relevant conflicts of interest relating to the contents of this manuscript and have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. The study received an unconditioned grant from A.C.R.A.F. Aziende Chimiche Riunite Angelini Francesco (S.P.A.) for the open access option.

Author contributions

All authors contributed in the study design and data interpretation, had accountable for all aspects of the work and approved the final manuscript as submitted. FP coordinated the study. LB, OB, RL, RB, SC, SDC, DDR and RLM wrote the initial draft. RLM performed the statistical analysis. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.