Background:Monthly audits of the management of the suspected fractured arm in KFEC showed variable delivery in analgesia for children presenting with suspected arm fractures.
Aims: To develop and implement an analgesia process whereby suspected paediatric forearm fractures consistently receive appropriate analgesia in the ED
Methods: We created an Intra-Nasal Fentanyl project whereby a core team used a large number of Plan-Do-Study-Act (PSDA) cycles to implement and evaluate the effectiveness of small individual changes on pain management.
Specific changes included: having ‘red folders’ to alert pain priority patients, adding scales to the triage area for early weighing, education sessions on pain management, having an Entonox bottle within the nurses station, regular staff feedback on current department performance, education during handovers and developing standing orders for quick Intra-nasal fentanyl delivery.
The effectiveness of each PSDA intervention was measured with monthly audits and staff feedback. Specific measures included the use of pain score at triage and during nursing assessments, time to pharmacological analgesia, use of fentanyl and timely use of fentanyl in patients with high pain scores. Other ongoing measures included repeat pain scores, and neurovascular observations.
Results: The proportion of patients with documented pain scores on nursing assessment increased from 34% to 71%. The proportion of patients with a pain score ?5 receiving IN Fentanyl increased from 42% to 75%. The mean time to any pharmacological analgesia reduced from 70 to 23 minutes
Conclusions: Small changes that are regularly evaluated are able to change and influence analgesia delivery in a busy emergency department. Creating systems where pain is able to be quickly identified, analgesia doses easy calculated and prescribed as well as medication easily dispensed has a dramatic effect on time to analgesia delivery and in turn improved patient care. Improved time to analgesia also had a flow on effect to improved continuation of care with increased repeat in pain scores and neurovascular observations.
Counties Manukau Health