P126: Analysis of acute pain management in the emergency department of a large private hospital in Cape Town, South Africa

Abstract

Introduction: Pain is a common presenting complaint amongst emergency department (ED) patients. Evidence suggests that pain is often inadequately and inconsistently treated resulting in oligoanalgesia. Patients that do not have their pain timeously recognised and treated end up with an inferior patient experience in the ED. It was speculated that pain management in Panorama Mediclinic ED was not optimal and an in-depth analysis of pain management trends was performed in order to lead to a targeted intervention which would result in better care in the ED. Methods: A convenience sample of 100 random folders was collected from May-July 2015. Folders with presenting complaints excluding pain and children under 10 years of age were excluded. The data were collected onto a password protected Excel database and analysed using basic descriptive analysis. Results: 44% of patients included were green triage category, 30% yellow, 23% orange and 1% red. 82% of patients presented with verbal pain scores greater than 5/10. The average time to receive analgesia was 60.26 minutes. 33.3% of patients only received analgesia after being in the ED for >60 minutes. Of those patients receiving delayed analgesia, the majority of their pain scores were between 6-8/10. Abdominal and extremity pain together consisted of 51% of the anatomical pain distribution. 29% of the patients sampled received no analgesia during their visit to the EC and the majority of their pain scores were between 3-6/10. Intravenous acetaminophen, intravenous opioids and intramuscular opioids are by far the most common pharmaceutical agents to treat acute pain in this ED. Conclusion: This study demonstrated that acute pain is not well managed in the ED of Panorama Mediclinic. Subsequently an acute pain management protocol was implemented in which all patients with pain scores greater than 5/10 are offered early analgesia on initial presentation to the ED by the triage nurse.