Organisation and implementation of acute pain management in German emergency departments—an online survey

Abstract

Background: Acute pain is the most common reason for patients to present at emergency departments (EDs). However, pain assessment and management in ED settings are not yet standardised in Germany and are therefore often described as insufficient. So far, there is no specialised national guideline regarding analgesia in German EDs. Thus, the role of nursing staff in pain management is not clearly defined and differs heavily depending on in-house standard operating procedures (SOPs). Methods: We conducted an online survey regarding the organisation and implementation of pain management in German EDs. The survey consisted of 18 questions. It was distributed via e‑mail to 951 members of the Notaufnahmeverzeichnis of the DGINA e. V. (Deutsche Gesellschaft für interdisziplinäre Notfall- und Akutmedizin). Results: We analysed datasets of 166 German EDs. 77.7% of these departments reported pain assessment within the first 10 min after patient arrival. The numeric rating scale appears to be the most commonly used assessment tool for acute pain (46.4%). 32.5% of EDs reported that nursing staff is not allowed to manage pain independently even though 17.7% of all EDs are not staffed with physicians 24/7. 44.8% use a specific SOP for pain management in EDs. The most commonly used opioids are piritramide and morphine, and the most commonly used non-opioids are metamizole and ibuprofen. Conclusion: A national guideline for pain therapy in EDs could help to establish certain standards and function as a reference for in-house SOPs. Moreover, it could provide guidance for better inclusion of nursing staff for early pain management, thus, leading to earlier and more sufficient pain relief for patients.