National project seeking to improve pain management in the emergency department setting: Findings from the NHMRC-NICS National Pain Management Initiative

Abstract

Objectives: The National Pain Management Initiative was established by the National Institute of Clinical Studies to improve analgesic practice across Australian EDs. Methods: A barrier analysis provided information to better implement changes in analgesic practice. A working party was established and developed a multifaceted intervention strategy and clinical indicators. An online data collection system was developed and sites collected data at three monthly intervals for 18 months. A stepped-wedge design was chosen to manage the number of hospitals involved. Clinical indicators included documentation of pain score, time to analgesia, appropriate use of parenteral narcotics and effectiveness of analgesia for severe pain. Results: A total of 16627 patient datasets were entered from 45 metropolitan and regional hospitals. There was an increase from 41% to 64% in documented pain score (difference in proportions 23%, 95% confidence interval: 20-26) and median time to analgesia fell from 61min (interquartile range: 23-122) to 41min (interquartile range: 15-95). Appropriate parenteral narcotic use was over 90% for all time points combined. For all patients with severe pain there was no significant change in the proportion with a documented reduction of pain within 1h of presentation. Conclusion: Significant improvements in documentation of pain score and time to analgesia were demonstrated through a national project of targeted improvement. Parenteral narcotic use has a high level of adherence to recommended practice. An improvement in the effectiveness of analgesia in severe pain has not been clearly demonstrated in this study. © 2012 NHMRC EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.