| Learning Objective #1: Understand the effect of an triage pain protocol on pain assessment and pain management for minor musculoskeletal injury patients in emergency department of Hong Kong | |||
| Learning Objective #2: Understand the analgesic efficacy, safety, and time to initial analgesia of using oral paracetamol at triage in emergency department of Hong Kong |
Methods In phase 1 (S1) baseline data (pre-test) was collected and a triage pain protocol was developed. In phase 2 (S2) a pain protocol was introduced and its effect was assessed. Two hundred and ninety-six patients aged 18years and who presented with minor musculoskeletal injury of an isolated single limb participated in this study: 97 patients in the S1 period and 199 patients in the S2 period. Interventions included (1) a triage pain protocol with pain assessment; (2) permission for the triage nurse to prescribe Paracetamol (panadol) at triage.
Result: There was an increase in the rate of nurse assessment of pain between the S1 and S2 phases (19% v 81%; p<0.0001). During S2, the time to initial analgesia was shorter in the triage paracetamol group compared with patients who waited for a doctor to prescribe analgesia (9 minutes Vs 93 minutes, P<0.005). The mean reduction in VAS after 60 minutes in the ED was 21mm in the nurse initiated Paracetamol group compared with 0.7 mm in those patients who did not receive analgesia at triage but rather waited for doctor initiated analgesia (Z =-3.251, P=0.001). No adverse effects of Paracetamol treatment were reported by participants. Introducing a nurse triage pain protocol and empowering nurses to prescribe analgesia for patients with minor musculoskeletal injury at triage resulted in an increased rate in pain assessment, earlier prescription of analgesia and an earlier reduction in pain score.