Pain Reassessment in the Emergency Department

Abstract:

Purpose and Background: Inadequate management of pain in the emergency department is a significant problem resulting in decreased patient satisfaction as well as poor patient outcomes. Reassessment of the patient’s pain after intervention is an essential component of successful pain management, as well as a requirement by the Joint Commission for Accreditation of Hospitals (JCAHO). Chart audits done in a Midwest trauma unit over a twelve month period revealed a lack of documentation of pain reassessment following pain intervention in an average of 45% of patients. In addition, the HCAP survey measuring satisfaction with pain management shows room for improvement. The purpose of this project was to create a protocol to improve pain reassessment documentation in the emergency department, resulting in better nursing management of pain. Literature Review:  Literature supports the importance of consistent and frequent reassessment of pain as a crucial step in pain management .Evidence has also shown that providing pain education for nurses along with individual feedback can be effective in improving pain reassessment. In addition, literature suggests patient satisfaction with pain management is improved with reassessments.  Protocol/Intervention: The pain documentation process within the ED was assessed, which identified varying documentation practices as well as varying methods of documentation.  Based on these findings, the protocol included education for nursing staff regarding required documentation for pain reassessments and the appropriate place for documentation.Documentation guidelines and standards were reviewed and clarified. Visual reminders were placed reminding staff to complete the pain reassessment, and feedback and support was provided to staff. The protocol is currently in the process of being implemented.Chart audits will continue to be monitored, with results communicated to nursing staff. Outcomes: It is expected that this protocol will  increase completion of pain reassessment by staff.As a result, it is expected that patients will experience better pain managment and will report improved satisfaction with the management of their pain.