Patients and emergency clinicians perceptions of improving pre-hospital pain management: a qualitative study
Emergency Medicine Journal, 05/08/2012
Iqbal M et al. – Pain is often poorly managed and undertreated in the pre–hospital environment. The authors' findings may be used to inform guidance, education and policy to improve the pre–hospital pain management pathway.Methods
- This was a qualitative study involving a single emergency medical system.
- Data were gathered through focus groups and semi-structured interviews.
- Participants were purposively sampled from patients transported by ambulance to hospital with a painful condition during the past 6 months, ambulance service and emergency department (ED) clinicians.
- Interviews were audiotaped, transcribed and thematic analysis was conducted.
- 55 participants were interviewed: 17 patients, 25 ambulance clinicians and 13 ED clinicians.
- Key themes included: consider beliefs of patients and staff in pain management; widen pain assessment strategies; optimise non-drug treatment;increase drug treatment options; and enhance communication and coordination along the pre-hospital pain management pathway.
- Patients and staff expected pain to be relieved in the ambulance; however, refusal of or inadequate analgesia were common.
- Pain was commonly assessed using a verbal score, but practitioners' views of severity were sometimes discordant with this.
- Morphine and Entonox were commonly used to treat pain.
- Reassurance, positioning and immobilisation were used as alternatives to drugs.
- Pre-hospital pain management could be improved by addressing practitioner and patient barriers, increasing available drugs and developing multi-organisational pain management protocols supported by training for staff.