A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain

• Published in: International emergency nursing 2016-07, Vol.27, p.3-10
• Main Authors: Pierik, Jorien G.J., Berben, Sivera A., IJzerman, Maarten J., Gaakeer, Menno I., van Eenennaam, Fred L., van Vugt, Arie B., Doggen, Carine J.M.
• Format: Article
• Language: English
• Subjects: Acute musculoskeletal pain; Analgesics; Clinically relevant pain relief; Emergency department; Nurse-initiated pain protocol
• ISSN: 1755-599X; 1532-9267
• DOI: 10.1016/j.ienj.2016.02.001

•The nurse-initiated pain protocol improved analgesic provision and administration.•A high percentage of patients refused to take analgesics.•Protocol implementation shortened time to analgesics, especially to first opioid.•Mean pain relief increased, with analgesic treatment even up to 2 NRS-points.•A high percentage of patients still suffered moderate to severe pain at ED discharge. While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre–post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre- (15 months, n = 504) and post-period (6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain (NRS ≥4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min (P