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Title: Analgesia in the emergency department: why is it not administered?
Austin Authors: Kant, Joyce;Dombagolla, Mahesha;Lai, Fiona;Hendarto, Andreas;Taylor, David McD 
Affiliation: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine and Radiology, University of Melbourne, Parkville, Victoria, Australia
Issue Date: Jan-2019
Date: 2018-10-30
Publication information: Emergency medicine journal 2019; 36(1):12-17
Abstract: Pain management in the ED is often suboptimal, with many patients not receiving analgesia. We aimed to determine why some patients refuse it, why others do not receive it, and whether these variables impact on patient satisfaction with their pain management. We undertook a prospective, observational study in a large, Australian, tertiary referral ED (February-May 2017). A convenience sample of consecutive adult patients with a triage pain score of ≥4 were examined. Data were collected from the medical record and the treating nurses. At follow-up at least 48 hours postdischarge, patients were asked if they received analgesia in the ED (if not, then why not) and how satisfied they were with their pain management (very dissatisfied/dissatisfied/slightly dissatisfied/slightly satisfied/satisfied/very satisfied). The primary outcome was why patients refuse analgesia. Of the 651 enrolled patients, 171 (26.3%) did not receive analgesia; for 30 (17.5%), patients and their nurses agreed that analgesia was refused. Patients mainly refused analgesia because their pain was not bad enough, they had recent analgesia intake, and concerns about side effects and interactions. Patients who received analgesia were more likely to be 'very satisfied' with their pain management (difference in proportions 10.8%, 95% CI 2.1 to 19.4). The satisfaction of patients who refused analgesia and those who did not receive analgesia for other reasons did not differ. Patient refusal is the most common reason for patients not receiving analgesia. Analgesia receipt is associated with greater patient satisfaction. However, a patient's knowledge of their analgesia receipt status may be incorrect. Disregard of the reasons for patients not receiving analgesia may underestimate the number offered analgesia.
DOI: 10.1136/emermed-2018-207629
ORCID: 0000-0002-8986-9997
Journal: Emergency medicine journal : EMJ
PubMed URL: 30377161
Type: Journal Article
Subjects: analgesia/pain control
emergency department
Appears in Collections:Journal articles

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