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Evaluation and management of pain in patients in the emergency trauma room: a best practice implementation project
Amanda Ximenes1, Adriana Nori1, Gabriella Novelli Oliveira1
1University Hospital, University of São Paulo, São Paulo, SP, Brazil.
Introduction:
Pain is a frequent complaint in emergency departments (ED), particularly among polytrauma patients, who often experience high levels of pain. The Advanced Trauma Life Support protocol is widely used to assess such patients, prioritizing life-threatening conditions through the ABCDE approach. However, pain documentation is often insufficient, and analgesia administration is frequently delayed, even in conscious patients able to report their pain.
Objectives:
This project aimed to promote evidence-based practices for pain assessment and management in an emergency trauma room.
Methods:
The project followed the seven-phase JBI Evidence Implementation Framework. A baseline audit assessed 211 patient records against seven audit criteria and barriers to best practices were identified. After the implementation of improvement strategies, a follow-up audit measured changes in compliance with best practices.
Results:
Key barriers included lack of pain documentation, absence of a reliable assessment scale, no reassessment after analgesia or before ED discharge, and delays in analgesic administration. To address these, a protocol for systematic pain evaluation was implemented, ensuring analgesia aligned with recorded scores, alongside training for medical and nursing teams. The follow-up audit demonstrated marked improvement across all criteria. Compliance exceeded 70% for pain documentation upon arrival in the ED using a validated tool and for analgesia administration based on recorded scores. Reassessment after analgesia and prior to discharge remained below 60%, likely reflecting structural challenges within the ED. Time to first analgesic dose was reduced, indicating progress in timely administration.
Conclusion:
The implementation strategies proved effective, improving the systematic care provided in the emergency trauma room of the ED, in alignment with best practices for the assessment and management of pain in polytrauma patients.
Spanish Abstract:
https://links.lww.com/IJEBH/A674.
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