4 steps to follow for severe pain
There are four key steps to take when treating severe pain in the ED, according to Robert S. Hockberger, MD, FACEP, chair of the department of emergency medicine at Harbor-University of California at Los Angeles Medical Center in Torrance.
"Implementation of a protocol like this one can remarkably improve care for most patients," he says. Here are the four steps to take:
1. Assess the patient’s pain.
For children or patients with whom you cannot communicate with because of language problems, use a scale of 1-10 or a series of faces showing an increasing degree of distress, recommends Hockberger.
2. Tell the patient you will treat his or her pain.
This expression of caring increases patient’s perception of your empathy and overall satisfaction with the care you provide, says Hockberger.
3. Start an IV and administer 1-2 mg of morphine sulfate per minute until the patient’s pain is significantly diminished.
The goal is changing severe pain (a score of 7-10) to mild pain (a score of 2-3). This change can almost always be accomplished within 10 to 15 minutes of presentation for most patients, Hockberger explains.
4. Assess your ED’s success in pain management by conducting a quality improvement project.
Measure the time from presentation to pain relief for a selected disorder (for example, fractures or burns) or for all patients who present with a pain score over 6 or 7 during a preset time period, Hockberger suggests.
"Comparing times before and after implementation of a protocol will almost always show a significant improvement," he says.
For more information about treating severe pain in the ED, contact:
• Robert S. Hockberger, MD, FACEP, Department of Emergency Medicine, Harbor-University of California at Los Angeles Medical Center, 1000 W. Carson St., Torrance, CA 90509. Telephone: (310) 222-3504. Fax: (310) 782-1763. E-mail: [email protected].
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