Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Kwan MK(1), Yeung JHH(1), Wong WCL(1)
Affiliation :
(1)Accident of Emergency Department, Princess Margaret Hospital
Introduction :
Pain assessment and management are very important to an injured patient’s comfort, safety and quality of life which is extremely and need to be started when patients attend the triage in Accident and Emergency Department (AED). Pain is one of the reasons why many patients attend to AED. However, pain assessment and related interventions in the triage sometimes are not performed because of heavy workload and limited time in the triage. However, due to the overcrowded and overwhelm workload of AED, the patients, especial Category 4 or below may need to wait for a long time before they see the doctors and received the pain-relieving interventions. In order to relieve patient’s pain as soon as possible, the nurse-led pain management program for limbs injury’s patients is implemented to improve patient care in AED.
Objectives :
Objectives of the program is to improve the pain management on limbs’ injury patients in AED which includes pain assessment, providing timely non-pharmacological pain relief interventions according to patient’s condition to reduce the pain, and review the effectiveness of the interventions.
The primary outcome is to reduce the pain level of the limbs injury’s patients, measured by self-report using NRS. The secondary outcomes are to increase the pain assessment compliance rate and decrease the time from attendance to intervention.
Methodology :
The important of pain assessment and pain relief were reemphasized. The triage nurses were encouraged to perform pain assessments by (Numeric Rating Scale) NRS score and provide related non-pharmacological interventions, which included applying cold pad, warm pad, splintage and bandaging, to eligible patients in the triage. Instruction on the indication of cold pad, warm pad, splint and materials were given and available in the triage station. The small note was attached in AE card to remind both medical and nursing staff for pain intervention and reassessment.
A pre-post program study was conducted to evaluate the outcome. The data was collected retrospectively via electronic medical record. The study was approved by the KWC Cluster Research Ethics Committee/Institutional Review Board.
Result & Outcome :
There were total 290 eligible patients, 140 in 1-month pre-program (1/4/2023 to 30/4/2023) compared with 150 eligible patients in 1-month post-program (15/11/2023 to 31/12/2023). The nurse-led pain management program significantly reduced pain which evidenced by decreased the mean NRS from 5.67 to 3.21(P< 0.001). Among those patients, 93.1% of them reported that the pain score reduced ≥2 and 2.57 in average. The compliance rate of initial pain assessment increased from (28) 20% to (103) 68.7% (P< 0.001) and from no routine pain reassessment to (102) 68.0% (P< 0.001) were reassessed. Patients who received pain-relief interventions were increased from (40) 28.6% to (114) 76% (P< 0.001). The time to intervention was decreased from a median 121minutes, IQR 204 minutes, to 17minutes, IQR 20minutes (P< 0.001).
Conclusion: Implementation of the nurse-led pain management program for limbs injury’s patients enhances the pain management in AED. It increased the pain assessment and easement rate and reduced the time form attendance to intervention. It also significantly relieved patients’ pain as evidenced by reduced pain level.
