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A nurse initiated analgesic protocol—The key to improved pain management in the emergency department
S34 Perceived efficiency was significantly higher on days with low throughput rates compared with days with high throughput rates. Days with short throughput were also characterized by higher perceived work-related efforts and quantity of work, but concurrently, work was perceived as more rewarding. In conclusion, days with low throughput rates may not only be related to a higher number of patients and longer transit times, but also to staff ratings of efficiency. Hence, there may be a divergence between objective measures of efficiency, such as throughput rates, and the perceived efficiency among staff. doi:10.1016/j.aenj.2011.09.083 A nurse initiated analgesic protocol—–The key to improved pain management in the emergency department 1,2,3,∗
Åsa Muntlin Athlin , Marianne Säfwenberg 3 , Lena Gunningberg 2,4
2
Carlsson , Urban
1
Department of Emergency Care, Uppsala University Hospital, Sweden 2 Department of Public Health and Caring Sciences, Uppsala University, Sweden 3 Department of Medical Sciences, Uppsala University, Sweden 4 Division of Surgery, Uppsala University Hospital, Sweden Keywords: Abdominal pain; Nursing intervention; Analgesic; Emergency department; Quality of care Background: The quality of the pain management in the emergency departments has been questioned. Surveys have shown that patients do not always receive analgesic despite pain and time to analgesic can be unreasonable long. By tradition the frequency of giving analgesics in emergency departments has been restricted due to risk for negative effects on the diagnosis. Aim: To investigate if the use of a nurse initiated intravenous analgesic protocol could improve the pain management for patients seeking emergency care for abdominal pain. Method: Totally, 200 patients participated in a quasiexperimental study (ABA phases). The inclusion criteria were as follows: adult persons with ongoing abdominal pain. The intervention consisted of two parts: (a) education to the registered nurses, (b) a nursing assessment protocol including a range order for morphine. The patients’ perceptions of the quality of care in pain management were evaluated with the SCQIPP questionnaire (Strategic and Clinical Quality Indicators in Postoperative Pain Management). Results: The nursing intervention resulted in significant improvement in number of patients receiving analgesics (65% vs. 46%) and decreased time to analgesic (mean time = 2.5 vs. mean time = 1.3 h; p = 0.001). Patients in phase B (intervention phase) rated higher in ‘‘perceived quality of patient participation’’ comparing to patients in phase A1 and A2 (standard procedure). There was also significant improvement in patients’ perceptions of the staff’s knowledge about pain management. Conclusions: The nursing intervention improved the pain management in the emergency department and the
patients’ perceptions of the quality of care in pain management. doi:10.1016/j.aenj.2011.09.084 ‘It’s the right level of care for me’: Evaluation of a nurseled emergency care clinic Åsa Muntlin Athlin 1,2 1
Department of Medical Sciences, Uppsala University, Sweden 2 Department of Public Health and Caring Sciences, Uppsala University, Sweden Keywords: Emergency care; Patient satisfaction; Nurse-led clinic; Quality of care Background: Limited access to health care centers might lead to increased non-urgent patient visits and long waiting times at emergency departments. A solution could be introduction of nurse-led emergency care clinics. However, more knowledge about the categories of patients visiting these clinics and the quality of care provided is required. Aim: The aim of the study was to investigate visit characteristics and patients’ perceptions of the quality of care at a Swedish nurse-led emergency care clinic. Method: The nurse-led emergency care clinic has a drop in function combined with pre-booked patient visits to a physician. To evaluate the quality of care, 300 patients answered the questionnaire QPP (Quality from the Patient’s Perspective). In addition, health records were studied to investigate visit characteristics. Results: The emergency care clinic treated patients with less urgent need of medical care as described in the clinic’s guidelines. Patients treated by a nurse were given, for example, advice for self-care and specific nursing interventions. Several patients were forwarded from the medical care hotline to either the nurse or to the physician. Patients perceived information, respect and engagement from the staff as of high quality. In addition, they were also satisfied with waiting times at the clinic. Conclusion: The nurse-led emergency care clinic treated patients on the intended level of care and the patients rated the quality of care as of high quality. However, to make the clinic more effective, more information to the general public and an extended collaboration with the medical care hotline is required. doi:10.1016/j.aenj.2011.09.085 The effectiveness of nurse-initiated two-level dispatch system of AED Emergency Response Team in response of emergency event in the vicinity of hospital C.H. Wong ∗ , S.S. Cheang Accident and Emergency Department, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, KLN, Hong Kong Keywords: Emergency in vicinity of hospital; Emergency response Introduction: In April 2009, we developed a two-level dispatch of Emergency Response Team (ERT) for the request of
Åsa Muntlin Athlin , Marianne Säfwenberg 3 , Lena Gunningberg 2,4
2
Carlsson , Urban
1
Department of Emergency Care, Uppsala University Hospital, Sweden 2 Department of Public Health and Caring Sciences, Uppsala University, Sweden 3 Department of Medical Sciences, Uppsala University, Sweden 4 Division of Surgery, Uppsala University Hospital, Sweden Keywords: Abdominal pain; Nursing intervention; Analgesic; Emergency department; Quality of care Background: The quality of the pain management in the emergency departments has been questioned. Surveys have shown that patients do not always receive analgesic despite pain and time to analgesic can be unreasonable long. By tradition the frequency of giving analgesics in emergency departments has been restricted due to risk for negative effects on the diagnosis. Aim: To investigate if the use of a nurse initiated intravenous analgesic protocol could improve the pain management for patients seeking emergency care for abdominal pain. Method: Totally, 200 patients participated in a quasiexperimental study (ABA phases). The inclusion criteria were as follows: adult persons with ongoing abdominal pain. The intervention consisted of two parts: (a) education to the registered nurses, (b) a nursing assessment protocol including a range order for morphine. The patients’ perceptions of the quality of care in pain management were evaluated with the SCQIPP questionnaire (Strategic and Clinical Quality Indicators in Postoperative Pain Management). Results: The nursing intervention resulted in significant improvement in number of patients receiving analgesics (65% vs. 46%) and decreased time to analgesic (mean time = 2.5 vs. mean time = 1.3 h; p = 0.001). Patients in phase B (intervention phase) rated higher in ‘‘perceived quality of patient participation’’ comparing to patients in phase A1 and A2 (standard procedure). There was also significant improvement in patients’ perceptions of the staff’s knowledge about pain management. Conclusions: The nursing intervention improved the pain management in the emergency department and the
patients’ perceptions of the quality of care in pain management. doi:10.1016/j.aenj.2011.09.084 ‘It’s the right level of care for me’: Evaluation of a nurseled emergency care clinic Åsa Muntlin Athlin 1,2 1
Department of Medical Sciences, Uppsala University, Sweden 2 Department of Public Health and Caring Sciences, Uppsala University, Sweden Keywords: Emergency care; Patient satisfaction; Nurse-led clinic; Quality of care Background: Limited access to health care centers might lead to increased non-urgent patient visits and long waiting times at emergency departments. A solution could be introduction of nurse-led emergency care clinics. However, more knowledge about the categories of patients visiting these clinics and the quality of care provided is required. Aim: The aim of the study was to investigate visit characteristics and patients’ perceptions of the quality of care at a Swedish nurse-led emergency care clinic. Method: The nurse-led emergency care clinic has a drop in function combined with pre-booked patient visits to a physician. To evaluate the quality of care, 300 patients answered the questionnaire QPP (Quality from the Patient’s Perspective). In addition, health records were studied to investigate visit characteristics. Results: The emergency care clinic treated patients with less urgent need of medical care as described in the clinic’s guidelines. Patients treated by a nurse were given, for example, advice for self-care and specific nursing interventions. Several patients were forwarded from the medical care hotline to either the nurse or to the physician. Patients perceived information, respect and engagement from the staff as of high quality. In addition, they were also satisfied with waiting times at the clinic. Conclusion: The nurse-led emergency care clinic treated patients on the intended level of care and the patients rated the quality of care as of high quality. However, to make the clinic more effective, more information to the general public and an extended collaboration with the medical care hotline is required. doi:10.1016/j.aenj.2011.09.085 The effectiveness of nurse-initiated two-level dispatch system of AED Emergency Response Team in response of emergency event in the vicinity of hospital C.H. Wong ∗ , S.S. Cheang Accident and Emergency Department, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, KLN, Hong Kong Keywords: Emergency in vicinity of hospital; Emergency response Introduction: In April 2009, we developed a two-level dispatch of Emergency Response Team (ERT) for the request of