DOI QR코드

DOI QR Code

Model Determination of Delayed Causes of Analgesics Prescription in the Emergency Ward in Arak, Iran

  • Cyrus, Ali (Department of Urology, Arak University of Medical Sciences) ;
  • Moghimi, Mehrdad (Department of Surgery, Shahid Beheshti University of Medical Sciences) ;
  • Jokar, Abolfazle (Department of Emergency Medicine, Arak University of Medical Sciences) ;
  • Rafeie, Mohammad (Department of Biostatistics, Arak University of Medical Sciences) ;
  • Moradi, Ali (Asasdabad Health and Treatment Network, Hamedan University of Medical Sciences) ;
  • Ghasemi, Parisa (Department of Urology, Arak University of Medical Sciences) ;
  • Shahamat, Hanieh (Department of Urology, Arak University of Medical Sciences) ;
  • Kabir, Ali (Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences)
  • Received : 2013.10.07
  • Accepted : 2014.01.17
  • Published : 2014.04.01

Abstract

Background: According to the reports of the World Health Organization 20% of world population suffer from pain and 33% of them suffer to some extent that they cannot live independently. Methods: This is a cross-sectional study which was conducted in the emergency department (ED) of Valiasr Hospital of Arak, Iran, in order to determine the causes of delay in prescription of analgesics and to construct a model for prediction of circumstances that aggravate oligoanalgesia. Data were collected during a period of 7 days. Results: Totally, 952 patients participated in this study. In order to reduce their pain intensity, 392 patients (42%) were treated. Physicians and nurses recorded the intensity of pain for 66.3% and 41.37% of patients, respectively. The mean (SD) of pain intensity according to visual analogue scale (VAS) was 8.7 (1.5) which reached to 4.4 (2.3) thirty minutes after analgesics prescription. Median and mean (SD) of delay time in injection of analgesics after the physician's order were 60.0 and 45.6 (63.35) minutes, respectively. The linear regression model suggested that when the attending physician was male or intern and patient was from rural areas the delay was longer. Conclusions: We propose further studies about analgesics administration based on medical guidelines in the shortest possible time and also to train physicians and nurses about pain assessment methods and analgesic prescription.

Keywords

References

  1. Fry M, Bennetts S, Huckson S. An Australian audit of ED pain management patterns. J Emerg Nurs 2011; 37: 269-74. https://doi.org/10.1016/j.jen.2010.03.007
  2. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med 1989; 7: 620-3. https://doi.org/10.1016/0735-6757(89)90286-6
  3. Ducharme J. Acute pain and pain control: state of the art. Ann Emerg Med 2000; 35: 592-603. https://doi.org/10.1016/S0196-0644(00)70033-3
  4. Marshall KW. Practical implications of cyclooxygenase2--specific inhibitors in orthopedics. Am J Orthop (Belle Mead NJ) 1999; 28: 19-21.
  5. Kelly AM. Patient satisfaction with pain management does not correlate with initial or discharge VAS pain score, verbal pain rating at discharge, or change in VAS score in the Emergency Department. J Emerg Med 2000; 19: 113-6. https://doi.org/10.1016/S0736-4679(00)00219-5
  6. Yee AM, Puntillo K, Miaskowski C, Neighbor ML. What patients with abdominal pain expect about pain relief in the emergency department. J Emerg Nurs 2006; 32: 281-7. https://doi.org/10.1016/j.jen.2006.04.014
  7. Zarei S, Bigizadeh S, Pourahmadi M, Ghobadifar MA. Chronic pain and its determinants: a population-based study in southern Iran. Korean J Pain 2012; 25: 245-53. https://doi.org/10.3344/kjp.2012.25.4.245
  8. Johnson SH. The social, professional, and legal framework for the problem of pain management in emergency medicine. J Law Med Ethics 2005; 33: 741-60. https://doi.org/10.1111/j.1748-720X.2005.tb00541.x
  9. Tcherny-Lessenot S, Karwowski-Soulié F, Lamarche-Vadel A, Ginsburg C, Brunet F, Vidal-Trecan G. Management and relief of pain in an emergency department from the adult patients' perspective. J Pain Symptom Manage 2003; 25: 539-46. https://doi.org/10.1016/S0885-3924(03)00147-7
  10. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain 2007; 8: 460-6. https://doi.org/10.1016/j.jpain.2006.12.005
  11. Berben SA, Meijs TH, van Dongen RT, van Vugt AB, Vloet LC, Mintjes-de Groot JJ, et al. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department. Injury 2008; 39: 578-85. https://doi.org/10.1016/j.injury.2007.04.013
  12. Jones JB. Assessment of pain management skills in emergency medicine residents: the role of a pain education program. J Emerg Med 1999; 17: 349-54. https://doi.org/10.1016/S0736-4679(98)00180-2
  13. Hawkins SC, Smeeks F, Hamel J. Emergency management of chronic pain and drug-seeking behavior: an alternate perspective. J Emerg Med 2008; 34: 125-9. https://doi.org/10.1016/j.jemermed.2007.07.001
  14. Arendts G, Fry M. Factors associated with delay to opiate analgesia in emergency departments. J Pain 2006; 7: 682-6. https://doi.org/10.1016/j.jpain.2006.03.003
  15. Wheeler E, Hardie T, Klemm P, Akanji I, Schonewolf E, Scott J, et al. Level of pain and waiting time in the emergency department. Pain Manag Nurs 2010; 11: 108-14. https://doi.org/10.1016/j.pmn.2009.06.005
  16. Grant PS. Analgesia delivery in the ED. Am J Emerg Med 2006; 24: 806-9. https://doi.org/10.1016/j.ajem.2006.05.004
  17. Lord B, Cui J, Kelly AM. The impact of patient sex on paramedic pain management in the prehospital setting. Am J Emerg Med 2009; 27: 525-9. https://doi.org/10.1016/j.ajem.2008.04.003
  18. Chen EH, Shofer FS, Dean AJ, Hollander JE, Baxt WG, Robey JL, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med 2008; 15: 414-8. https://doi.org/10.1111/j.1553-2712.2008.00100.x
  19. Marquie L, Raufaste E, Lauque D, Mariné C, Ecoiffier M, Sorum P. Pain rating by patients and physicians: evidence of systematic pain miscalibration. Pain 2003; 102: 289-96. https://doi.org/10.1016/S0304-3959(02)00402-5
  20. Weisse CS, Sorum PC, Dominguez RE. The influence of gender and race on physicians' pain management decisions. J Pain 2003; 4: 505-10. https://doi.org/10.1016/j.jpain.2003.08.002
  21. Ng B, Dimsdale JE, Rollnik JD, Shapiro H. The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain. Pain 1996; 66: 9-12. https://doi.org/10.1016/0304-3959(96)02955-7
  22. Iyer RG. Pain documentation and predictors of analgesic prescribing for elderly patients during emergency department visits. J Pain Symptom Manage 2011; 41: 367-73. https://doi.org/10.1016/j.jpainsymman.2010.04.023
  23. Young MF, Hern HG, Alter HJ, Barger J, Vahidnia F. Racial differences in receiving morphine among prehospital patients with blunt trauma. J Emerg Med 2013; 45: 46-52. https://doi.org/10.1016/j.jemermed.2012.07.088
  24. Kosiński S, Siudut B. Pain treatment in the emergency department: what do patients think? Anestezjol Intens Ter 2011; 43: 234-8.
  25. Eder SC, Sloan EP, Todd K. Documentation of ED patient pain by nurses and physicians. Am J Emerg Med 2003; 21: 253-7. https://doi.org/10.1016/S0735-6757(03)00041-X
  26. Tanabe P, Thomas R, Paice J, Spiller M, Marcantonio R. The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma. J Emerg Nurs 2001; 27: 124-31. https://doi.org/10.1067/men.2001.114386
  27. Marinsek M, Kovacic D, Versnik D, Parasuh M, Golez S, Podbregar M. Analgesic treatment and predictors of satisfaction with analgesia in patients with acute undifferentiated abdominal pain. Eur J Pain 2007; 11: 773-8. https://doi.org/10.1016/j.ejpain.2006.12.002
  28. Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med 2004; 43: 494-503. https://doi.org/10.1016/j.annemergmed.2003.11.019
  29. Guru V, Dubinsky I. The patient vs. caregiver perception of acute pain in the emergency department. J Emerg Med 2000; 18: 7-12. https://doi.org/10.1016/S0736-4679(99)00153-5
  30. Puntillo K, Neighbor M, O'Neil N, Nixon R. Accuracy of emergency nurses in assessment of patients' pain. Pain Manag Nurs 2003; 4: 171-5. https://doi.org/10.1016/S1524-9042(03)00033-X