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Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline
Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline
Introduction: acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was developed. The aim of this study was to assess whether current practice is in compliance with the guideline ‘Pain management for trauma patients in the chain of emergency care’ from the Netherlands Association for Emergency Nurses (in Dutch NVSHV), and to evaluate early and initial pain management for adult trauma patients in emergency care.

Methods: chart reviews were conducted in three regions of the Netherlands using electronic patient files of trauma patients from the chain of emergency care. We included one after-hours General Practitioner Co-operation (GPC), one ambulance Emergency Medical Services (EMS), two Helicopter Emergency Medical Services (HEMS), and three Emergency Departments (EDs). Organisation of pain management, pain assessment, and pain treatment was examined and compared with national guideline recommendations, including quality indicators.

Results: we assessed a random sample of 1066 electronic patient files. The use of standardised tools to assess pain was registered in zero to 52% of the electronic patient files per organisation. Registration of (non-)pharmacological pain treatment was found in less than half of the files. According to the files, pharmacological pain treatment deviated from the guideline in 73–99% of the files. Time of administration of medication was missing in 73–100%. Reassessment of pain following pain medication was recorded in half of the files by the HEMS, but not in files of the other organisations.

Conclusions: the (registration of) current pain management in trauma patients in the chain of emergency care varies widely between healthcare organisation, and deviates from national guideline recommendations. Although guideline compliance differs across groups of healthcare professionals, maximum compliance rate with indicators registered is 52%. In order to improve pain management and evaluate its effectiveness, we recommend to improve pain registration in patient files. Furthermore, we advise to identify barriers and facilitators related to the implementation of the national guideline in all emergency care organisations
0020-1383
798-806
Scholten, A.C.
4846c924-31ca-495b-a475-2d7f9bfcb07b
Berben, S.A.A.
ac5f29d8-5463-4a1c-8307-ba3e681e44d4
Westmaas, A.H.
f42317be-5c03-4326-8f6e-0195a16e8af3
van Grunsven, P.M.
7eef6e43-cb13-46ae-95d8-d935110d0ab5
de Vaal, E.T.
46662810-bcae-44b8-b645-e6238dfa35c7
Rood, P.P.M.
6105b709-5197-4945-801d-6941659bdee9
Hoogerwerf, N.
9c48f73e-1595-4232-8e70-2abd3b50ba80
Doggen, C.J.M.
2cca91a8-9f33-4082-8bb4-22040bd4c243
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Scholten, A.C.
4846c924-31ca-495b-a475-2d7f9bfcb07b
Berben, S.A.A.
ac5f29d8-5463-4a1c-8307-ba3e681e44d4
Westmaas, A.H.
f42317be-5c03-4326-8f6e-0195a16e8af3
van Grunsven, P.M.
7eef6e43-cb13-46ae-95d8-d935110d0ab5
de Vaal, E.T.
46662810-bcae-44b8-b645-e6238dfa35c7
Rood, P.P.M.
6105b709-5197-4945-801d-6941659bdee9
Hoogerwerf, N.
9c48f73e-1595-4232-8e70-2abd3b50ba80
Doggen, C.J.M.
2cca91a8-9f33-4082-8bb4-22040bd4c243
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de

Scholten, A.C., Berben, S.A.A., Westmaas, A.H., van Grunsven, P.M., de Vaal, E.T., Rood, P.P.M., Hoogerwerf, N., Doggen, C.J.M. and Schoonhoven, Lisette (2015) Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline. Injury, 46 (5), 798-806. (doi:10.1016/j.injury.2014.10.045). (PMID:25487830)

Record type: Article

Abstract

Introduction: acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was developed. The aim of this study was to assess whether current practice is in compliance with the guideline ‘Pain management for trauma patients in the chain of emergency care’ from the Netherlands Association for Emergency Nurses (in Dutch NVSHV), and to evaluate early and initial pain management for adult trauma patients in emergency care.

Methods: chart reviews were conducted in three regions of the Netherlands using electronic patient files of trauma patients from the chain of emergency care. We included one after-hours General Practitioner Co-operation (GPC), one ambulance Emergency Medical Services (EMS), two Helicopter Emergency Medical Services (HEMS), and three Emergency Departments (EDs). Organisation of pain management, pain assessment, and pain treatment was examined and compared with national guideline recommendations, including quality indicators.

Results: we assessed a random sample of 1066 electronic patient files. The use of standardised tools to assess pain was registered in zero to 52% of the electronic patient files per organisation. Registration of (non-)pharmacological pain treatment was found in less than half of the files. According to the files, pharmacological pain treatment deviated from the guideline in 73–99% of the files. Time of administration of medication was missing in 73–100%. Reassessment of pain following pain medication was recorded in half of the files by the HEMS, but not in files of the other organisations.

Conclusions: the (registration of) current pain management in trauma patients in the chain of emergency care varies widely between healthcare organisation, and deviates from national guideline recommendations. Although guideline compliance differs across groups of healthcare professionals, maximum compliance rate with indicators registered is 52%. In order to improve pain management and evaluate its effectiveness, we recommend to improve pain registration in patient files. Furthermore, we advise to identify barriers and facilitators related to the implementation of the national guideline in all emergency care organisations

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More information

Accepted/In Press date: 10 October 2014
Published date: May 2015
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 380939
URI: http://eprints.soton.ac.uk/id/eprint/380939
ISSN: 0020-1383
PURE UUID: 0be00fab-1237-4593-ad88-5487931d7f84
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 21 Sep 2015 11:18
Last modified: 15 Mar 2024 03:41

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Contributors

Author: A.C. Scholten
Author: S.A.A. Berben
Author: A.H. Westmaas
Author: P.M. van Grunsven
Author: E.T. de Vaal
Author: P.P.M. Rood
Author: N. Hoogerwerf
Author: C.J.M. Doggen

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