A protocol to improve analgesia use in the accident and emergency department

• Published in: Emergency medicine journal : EMJ 1996-05, Vol.13 (3), p.177-179
• Main Authors: Goodacre, S W, Roden, R K
• Format: Article
• Language: English
• Subjects: Analgesia - methods; Analgesia - trends; Emergency Service, Hospital; Fractures, Bone - therapy; Guidelines as Topic; Humans; Musculoskeletal System - injuries; Orthopedics - standards; Quality of Health Care; United Kingdom
• ISSN: 1351-0622; 1472-0205; 1472-0213
• DOI: 10.1136/emj.13.3.177

OBJECTIVE--To assess the use of analgesia in an accident and emergency (A&E) department and identify shortcomings. SETTING--University teaching hospital. METHODS--An audit of patients referred from the A&E department to orthopaedic fracture clinic (n = 100) or for orthopaedic admission (n = 100) was carried out to document analgesia use. An analgesia protocol was introduced and analgesia use was reassessed on the same numbers of patients. RESULTS--Prescribing of analgesia was initially poor: 91% of fracture clinic referrals and 39% of admissions received no analgesia while in the A&E department; when given, it was often by inappropriate routes. Introduction of an analgesia protocol significantly improved analgesia use: fracture clinic referrals receiving unsatisfactory analgesia were reduced from 91% to 69% (P < 0.001). There was a marked increase in the use of intravenous analgesia, from 9% to 37% (P < 0.001). CONCLUSIONS--Large numbers of patients still receive no analgesia while in the A&E department. This seems to be a common problem requiring intervention at a national level. The absence of a coordinated approach to improving analgesia provision for acute trauma in the United Kingdom should be addressed urgently.