Cargando…

Improving timely analgesia administration for musculoskeletal pain in the emergency department

Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits...

Descripción completa

Detalles Bibliográficos
Autores principales: Woolner, Victoria, Ahluwalia, Reena, Lum, Hilary, Beane, Kevin, Avelino, Jackie, Chartier, Lucas B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011892/
https://www.ncbi.nlm.nih.gov/pubmed/31986116
http://dx.doi.org/10.1136/bmjoq-2019-000797
_version_ 1783496148407812096
author Woolner, Victoria
Ahluwalia, Reena
Lum, Hilary
Beane, Kevin
Avelino, Jackie
Chartier, Lucas B
author_facet Woolner, Victoria
Ahluwalia, Reena
Lum, Hilary
Beane, Kevin
Avelino, Jackie
Chartier, Lucas B
author_sort Woolner, Victoria
collection PubMed
description Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits specific for musculoskeletal (MSK) injuries. Our aim was to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 min) in 9 months’ time (May 2018). Our outcome measures included mean TTA and ED length of stay (LOS). Process measures included rates of analgesia administration and of use of medical directives. We obtained weekly data capture for Statistical Process Control (SPC) charts, as well as Mann-Whitney U tests for before-and-after evaluation. We performed wide stakeholder engagement, root cause analyses and created a Pareto Diagram to inform Plan–Do–Study–Act (PDSA) cycles, which included: (1) nurse-initiated analgesia at triage; (2) a new triage documentation aid for medication administration; (3) a quick reference medical directive badge for nurses; and (4) weekly targeted feedback of the project’s progress at clinical team huddle. TTA decreased from 129 min (n=153) to 100 min (22.5%; n=87, p<0.05). Special cause variation was identified on the ED LOS SPC chart with nine values below the midline after the first PDSA. The number of patients that received any analgesia increased from 42% (n=372) to 47% (n=192; p=0.13) and those that received them via medical directives increased from 22% (n=154) to 44% (n=87; p<0.001). We achieved a significant reduction of TTA and an increased use of medical directives through front-line focused improvements.
format Online
Article
Text
id pubmed-7011892
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-70118922020-02-25 Improving timely analgesia administration for musculoskeletal pain in the emergency department Woolner, Victoria Ahluwalia, Reena Lum, Hilary Beane, Kevin Avelino, Jackie Chartier, Lucas B BMJ Open Qual Quality Improvement Programme Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits specific for musculoskeletal (MSK) injuries. Our aim was to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 min) in 9 months’ time (May 2018). Our outcome measures included mean TTA and ED length of stay (LOS). Process measures included rates of analgesia administration and of use of medical directives. We obtained weekly data capture for Statistical Process Control (SPC) charts, as well as Mann-Whitney U tests for before-and-after evaluation. We performed wide stakeholder engagement, root cause analyses and created a Pareto Diagram to inform Plan–Do–Study–Act (PDSA) cycles, which included: (1) nurse-initiated analgesia at triage; (2) a new triage documentation aid for medication administration; (3) a quick reference medical directive badge for nurses; and (4) weekly targeted feedback of the project’s progress at clinical team huddle. TTA decreased from 129 min (n=153) to 100 min (22.5%; n=87, p<0.05). Special cause variation was identified on the ED LOS SPC chart with nine values below the midline after the first PDSA. The number of patients that received any analgesia increased from 42% (n=372) to 47% (n=192; p=0.13) and those that received them via medical directives increased from 22% (n=154) to 44% (n=87; p<0.001). We achieved a significant reduction of TTA and an increased use of medical directives through front-line focused improvements. BMJ Publishing Group 2020-01-07 /pmc/articles/PMC7011892/ /pubmed/31986116 http://dx.doi.org/10.1136/bmjoq-2019-000797 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Quality Improvement Programme
Woolner, Victoria
Ahluwalia, Reena
Lum, Hilary
Beane, Kevin
Avelino, Jackie
Chartier, Lucas B
Improving timely analgesia administration for musculoskeletal pain in the emergency department
title Improving timely analgesia administration for musculoskeletal pain in the emergency department
title_full Improving timely analgesia administration for musculoskeletal pain in the emergency department
title_fullStr Improving timely analgesia administration for musculoskeletal pain in the emergency department
title_full_unstemmed Improving timely analgesia administration for musculoskeletal pain in the emergency department
title_short Improving timely analgesia administration for musculoskeletal pain in the emergency department
title_sort improving timely analgesia administration for musculoskeletal pain in the emergency department
topic Quality Improvement Programme
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011892/
https://www.ncbi.nlm.nih.gov/pubmed/31986116
http://dx.doi.org/10.1136/bmjoq-2019-000797
work_keys_str_mv AT woolnervictoria improvingtimelyanalgesiaadministrationformusculoskeletalpainintheemergencydepartment
AT ahluwaliareena improvingtimelyanalgesiaadministrationformusculoskeletalpainintheemergencydepartment
AT lumhilary improvingtimelyanalgesiaadministrationformusculoskeletalpainintheemergencydepartment
AT beanekevin improvingtimelyanalgesiaadministrationformusculoskeletalpainintheemergencydepartment
AT avelinojackie improvingtimelyanalgesiaadministrationformusculoskeletalpainintheemergencydepartment
AT chartierlucasb improvingtimelyanalgesiaadministrationformusculoskeletalpainintheemergencydepartment