Implementation of a guideline to improve prescription of analgesia for adult trauma patients in an Emergency Department

Objectives

To improve pain management of patients presenting to the emergency department with traumatic injuries through the development and implementation of a trauma pain guideline.

Methods

A retrospective review of 100 Emergency Department trauma patients (50 intubated and 50 non-intubated) was conducted in June 2005. Pain management guidelines were developed by the multidisciplinary group and implemented through intensive staff education in December 2005 and again in February 2006. A second review was conducted in April–June 2006.

Results

There was a significant increase in the number of intubated patients receiving analgesia in the post-implementation group, 32% (16/50) compared to 68% (34/50) (p=0.0002). Use of morphine and midazolam infusions, a specific recommendation of the guideline, increased from 16% (8/50) to 36% (18/50) (p=0.02), and the use of sedation (other than midazolam) together with analgesia increased from 16% (8/50) to 32% (18/50) (p=0.02).

In the non-intubated group the use of analgesia increased from 86% (43/50) to 100% (50/50) (p=0.006). Median time to analgesia decreased from 38min to 14min and the use of multimodal analgesia increased from 30% (15/50) to 61% (30/50) (p=0.002).

Conclusion

The implementation of trauma pain management guidelines and associated education has resulted in improved analgesic use in trauma patients in the emergency department.