Research Article
Volume 3 Issue 2 - 2021
Quality of Pain Assessment for Emergency Department Nurses and Physicians at a Tertiary Hospital
Gassan Abudari1*, Dina Aljawi1, Kholoud Almass2, Spasie Botha2 and Sukaina Alhunaidi2
1Palliative Care Clinical Nurse Specialist, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
2Pain Clinical Nurse Specialist, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
*Corresponding Author: Gassan Abudari, Palliative Care Clinical Nurse Specialist, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Received: November 04, 2020; Published: January 21, 2021




Abstract

Background: Assessment of patients’ pain has been identified as crucial for pain management. Studies confirm that clinicians underestimate patients’ levels of pain. Poor assessment of pain can eventually lead to undertreating pain and eventually influence patients’ quality of life. The Emergency Department (ED) is considered the most challenging area for nurses and physicians to provide quality pain management. The quality of pain assessment has a prominent influence on the process of pain management in the ED.

Purpose of the Study: This study aims to measure the degree of congruence between pain characteristics as described by ED patients and the attending nurses’ and physicians’ documentation of pain assessment as well as the analgesia prescription pattern by ED and primary physicians.

Method: This study used a descriptive and quantitative design. 131 patients of ED admission were selected based on inclusion and exclusion criteria. The investigators interviewed patients and collected data to measure the level of pain congruency as well as sample demographics.

Results: Patient self-reported mean score was equal to 6.7 (SD = 2.3), whereas the nurses assessed pain mean score was equal to 4.9 (SD = 2.1). The paired t-test showed that the nurses significantly underestimated patients’ pain scores t(102) = 8.4, p < 0.001). This result highlights an overall incongruence of nurses’ scores with patient self-rating pain score. Regarding to the physicians, the analyzable scores were too small (n = 16) due to excessive missing documented pain scores by the primary physicians. The mean total number of conformities of nurses documented pain (score, location, frequency and character) was equal to 2.2 out of a maximum possible score of (= 4 points).

Conclusion/Application to Practice: The results indicate a modest compliance to the pain assessment documentation standards for nurses and physicians, which reflects a poor quality of pain assessment among healthcare providers in ED. It is recommended to further investigate the reasons for pain underestimation by nurses and the physicians poor pain documentation. A periodical quality audit is needed to reinforce the application of pain assessment documentation standards. Investigating physicians’ pain management knowledge and compliance to pain management guidelines is required.

Keywords: Pain Assessment; Pain Documentation; Emergency Department; Nurses; Physicians; Saudi Arabia

References

  1. Cordell WH., et al. “The high prevalence of pain in emergency medical care”. The American Journal of Emergency Medicine3 (2002): 165-169.
  2. Karwowski-Soulié F., et al. “Pain in an emergency department: an audit”. European Journal of Emergency Medicine4 (2006): 218-224.
  3. Motov SM and Khan AN. “Problems and barriers of pain management in the emergency department: Are we ever going to get better?” Journal of Pain Research 2 (2008): 5-11.
  4. Pines JM and Hollander JE. “Emergency department crowding is associated with poor care for patients with severe pain”. Annals of Emergency Medicine1 (2008): 1-5.
  5. Stalnikowicz R., et al. “Undertreatment of acute pain in the emergency department: a challenge”. International Journal for Quality Health Care2 (2005): 173-176.
  6. Briggs E. “Assessment and expression of pain”. Nursing Standard2 (2010): 35-38.
  7. Turk DC and Melzack R. “Handbook of pain assessment”. Guilford Press (2011).
  8. Katz N. “The impact of pain management on quality of life”. Journal of Pain and Symptom Management1-1 (2002): S38-S47.
  9. Pollack CV and Viscusi ER. “Improving acute pain management in emergency medicine”. Hospital Practice1 (2015): 36-45.
  10. Sinatra RS., et al. “Acute pain management”. Cambridge University Press (2009).
  11. Breivik H., et al. “Assessment of pain”. British Journal of Anaesthesia1 (2008): 17-24.
  12. Dansie EJ and Turk DC. “Assessment of patients with chronic pain”. British Journal of Anaesthesia1 (2013): 19-25.
  13. Lewen H., et al. “Documented assessments and treatments of patients seeking emergency care because of pain”. Scandinavian Journal of Caring Sciences4 (2010): 764-771.
  14. Todd KH., et al. “Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study”. The Journal of Pain6 (2007): 460-466.
  15. Baharuddin KA., et al. “Assessing patient pain scores in the emergency department”. The Malaysian Journal of Medical Sciences: MJMS1 (2010): 17.
  16. Eder SC., et al. “Documentation of ED patient pain by nurses and physicians”. The American Journal of Emergency Medicine 4 (2003): 253-257.
  17. Iyer RG. “Pain documentation and predictors of analgesic prescribing for elderly patients during emergency department visits”. Journal of Pain and Symptom Management 2 (2011): 367-373.
  18. Duignan M and Dunn V. “Congruence of pain assessment between nurses and emergency department patients: a replication”. International Emergency Nursing 1 (2008): 23-28.
  19. Puntillo K., et al. “Accuracy of emergency nurses in assessment of patients' pain”. Pain Management Nursing 4 (2003): 171-175.
  20. Modanloo M., et al. “Comparison of pain assessment by patients and triage nurses”. Journal of Critical Care Nursing 1 (2010): 9-10.
  21. Berry PH and Dahl JL. “The new JCAHO pain standards: Implications for pain management nurses”. Pain Management Nursing 1 (2000): 3-12.
  22. Gordon DB., et al. “American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force”. Archives Internal Medicine 14 (2005): 1574-1580.
  23. Weingart SN., et al. “Assessing the quality of pain care in ambulatory patients with advanced stage cancer”. Journal of Pain and Symptom Management 6 (2012): 1072-1081.
  24. Stang AS., et al. “Quality indicators for the assessment and management of pain in the emergency department: A systematic review”. Pain Research and Management: The Journal of the Canadian Pain Society6 (2014): e179.
  25. Gordon DB., et al. “Improving reassessment and documentation of pain management”. The Joint Commission Journal on Quality and Patient Safety9 (2008): 509-517.
  26. Sturesson L., et al. “Actions to improve documented pain assessment in adult patients with injury to the upper extremities at the Emergency Department–a cross-sectional study”. International Emergency Nursing 25 (2016): 3-6.
  27. Chisholm CD., et al. “A comparison of observed versus documented physician assessment and treatment of pain: the physician record does not reflect the reality”. Annals of Emergency Medicine 4 (2008): 383-389.
  28. Giusti GD., et al. “Pain assessment in the Emergency Department. Correlation between pain rated by the patient and by the nurse. An observational study”. Acta Bio-medica: Atenei Parmensis4 (2018): 64-70.
  29. Abdalrahim MS., et al. “Documentation of postoperative pain by nurses in surgical wards”. Acute Pain2 (2008): 73-81.
  30. Idvall E and Ehrenberg A. “Nursing documentation of postoperative pain management”. Journal of Clinical Nursing6 (2002): 734-742.
  31. Ista E., et al. “Do implementation strategies increase adherence to pain assessment in hospitals? A systematic review”. International Journal of Nursing Studies4 (2013): 552-568.
  32. Pierik JG., et al. “Painful discrimination in the emergency department: risk factors for underassessment of patients’ pain by nurses”. Journal of Emergency Nursing3 (2017): 228-238.
  33. Platts-Mills TF., et al. “Older US emergency department patients are less likely to receive pain medication than younger patients: results from a national survey”. Annals of Emergency Medicine2 (2012): 199-206.
  34. Vuille M., et al. “Pain assessment by emergency nurses at triage in the emergency department: A qualitative study”. Journal of Clinical Nursing3-4 (2018): 669-676.
  35. Sinnenberg LE., et al. “What factors affect physicians’ decisions to prescribe opioids in emergency departments?” MDM Policy and Practice1 (2017): 2381468316681006.
  36. Dale J and Bjørnsen LP. “Assessment of pain in a Norwegian Emergency Department”. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine1 (2015): 86.
Citation: Gassan Abudari., et al. “Quality of Pain Assessment for Emergency Department Nurses and Physicians at a Tertiary Hospital”. EC Nursing and Healthcare 3.2 (2021): 87-101.

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