1. Improving Early Acute Pain
Management in an Academic
Tertiary Centre Emergency
Department
K Nixon1, 2 G Martin1 M McGowan1 D MacKinnon1, 2
Gaunt1 G Bandiera1 L Barratt1 E Nagatu1 N Ahmed2
M Bawazeer2 and J Spence1
on behalf of the St. Michael’s Hospital Department of
Emergency Medicine1 and Trauma Program2
K

2. Early Acute Pain Management in the ED
Context
• Significant number of patients come to the Emergency Department with acute pain;
however, assessing and treating acute pain may not always be as timely as staff and
patients wish with competing clinical priorities and limitations of space and volume
Problem and Issue
• Best practices suggest that pain management for the
emergency and trauma patient should be a priority in order to
prevent complications of acute pain and maintain the validity
of clinical assessment findings; however, under-treatment of
acute pain (oligoanalgesia) is well documented and is a
common source for patient dissatisfaction
• Pain is a dimension of patient satisfaction that is measured
with the validated NRC Picker; however, caution must be
heeded with interpretation - low response rate, patient recall
and precludes those with mental illness, homeless/sheltered
and admitted to hospital

3. Early Acute Pain Management in the ED
Measurement
Pain Management Beliefs. 45-question survey on knowledge of pain management
 Patient is most accurate judge of intensity of pain communicated reliably with a
10-point scale (MD 74%, RN 67%)
 Pain management is of equal priority with other aspects of clinical care (RN 85%,
MD 77%); however staff estimated only 51-75% achieved pain relief satisfaction
(RN 46%, MD 38%)
 Additional barriers to effective pain
management were clinical volume, work load
and waiting for diagnostics or adequate
treatment space
Patient Report. 10-question survey insitu.
54% perceived minimal delay until Emergency staff
(MD 43%, RN 31%, both 8%) discussed pain relief,
with medication options being most prominent
(80%); perception of adequate pain relief (yes 42%,
no 31%) was mixed though most (79%) felt staff
were doing everything they could
Figure 1. Reason for Inadequate Pain Management

4. Early Acute Pain Management in the ED
Contribution to Patient Safety & Quality Improvement
• Quality patient care includes providing early and
effective pain management
• A best-practices informed standardized medication
order set was implemented and facilitates safe
prescribing and timely administration of opioids for
acute pain in the Emergency Department.
• A collaborative approach, engaging the expertise and
champions from the Acute Pain Service, Pharmacy,
Nursing Professional Practice, Quality & Risk
Management, Emergency Nursing, General Surgery
and the Emergency and Trauma management and
physician groups has led to enhanced monitoring of
process, quality indices and engagement with the
patient experience