Improving pain management in the Emergency Department

Quality Improvement Poster Download

Background & Problem

In March 2015 the CQC inspected Gloucestershire Hospitals, including the Emergency Departments. A part of their subsequent report specifically identified pain management as an area requiring action stating ‘..patients within the emergency department should have an assessment of their pain and prompt pain relief administered where necessary..’. This matches the national standards for ED pain management set out by the Royal College of Emergency Medicine.

Aim

This project therefore aimed to identify the target areas for change and then, through these changes, improve the level of pain management within Cheltenham/Gloucester emergency departments. The initial aim was to have 50% patients meeting royal college standards, and thus the CQC criteria, within 12 months.

Method

An initial audit was undertaken to establish baseline data. From background literature review and staff questionnaires change areas were identified as increased education within the department, improved nurse prescribing, improved knowledge and access to non-pharmacological techniques, and improved documentation.

Over the following 7 months an education program was run out, posters were produced for the departments, pain management was incorporated into both nursing and medical inductions, and pain assessment and review was included in a newly introduced department checklist to aid documentation. Run charts were performed as each change was introduced in a cumulative form.

Results

A re audit performed after the introduction of the changes shows 99.3% patients were having pain assessed on arrival, 73.2% in moderate-severe pain had analgesia; therefore achieving the project aim.

Implications

This project has shown the toughness of introducing change within a busy department. Such things require persistence and creative repetition of the same messages. It will need continuation of this persistence in conjunction with continuing change improvements, such as nurse prescribing and learning resources, for the improvements to carry on.