Improving Pain Medication Delivery for Fractures in the Emergency Department
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Session D presented Friday, September 15, 2017
Purpose: The purpose of this project is to decrease the average time for delivery of initial pain management for patients presenting with long bone fractures.
Design: This is a leadership development project to improve provider and staff awareness through education, establishing a standardized protocol related to ordering and administering eligible pain medication, and making pain medication more accessible to providers and staff in the areas where it is being administered to patients. The emergency department triage area was modified to allow for a private visit area for providers to quickly assess patients before they are brought back to the main treatment area.
Setting: This project was implemented at a community hopsital emergency department which treats adults and pediatrics with a census of 40,000 patients yearly.
Participants/Subjects: All emergency department personnel participated in this project. This project has support from senior leadership, physician, pharmacy and nursing leadership, and emergency department charge nurses. Education and audits were conducted weekly to monitor the progress of pain medication administration. Education included the specific requirements for meeting core measures. Audits were conducted to identify providers and staff who had delays in pain medication administration with follow up on each case.
Methods: In order to decrease the amount of time for pain management in patients with long bone fractures this facility established a process to facilitate delivery of pain medication by improving access to medications and focusing on completing required documentation. The team also installed an Omnicell in the triage area and adopted changes, with continued feedback to providers keeping them apprised of ongoing monthly performance measures.
Results/Outcomes: The national recommended average time to provide pain management for patiens with long bone fractures is 54 minutes. By implementing established protocols and better accessibility to pain medications this facility was able to decrease delivery of pain medications to patients with long bone fractures from 55.4 minutes to 44.3 minutes (20% reduction).
Implications: This facility will continue to monitor performance and leverage lessons learned to improve additional throughput opportunities in the emergency deparment and the other parts of the hospital with which the emergency department interacts. As Joint Commission regularly introduces new measures it is important to educate and inform the providers of the requirements of any new measures. Pharmacy was reluctant to place an Omnicell in triage. By continuing to have discussions, devleoping a limited stock for a triage Omnicell, and granting very limited access, a level of comfort was reached in order to implement this particular change. A extremity pain control protocol was implemented to allow standing orders for nurses to administer certain pain medications when no bony deformity is present.