The Use of a Nurse-Initiated Pain Protocol in the Emergency Department for Patients with Musculoskeletal Injury: A Pre-Post Intervention Study

Background and Aim: As a common complaint of patients with traumatic injuries, pain remains undermanaged in emergency departments (EDs). Our aim was to evaluate the effects of a nurse-initiated pain management protocol in patients with musculoskeletal injuries in an ED in Iran. Material and Methods: This pre-post intervention design study was conducted on 240 patients with orthopedic injuries selected through sequential sampling over two phases. The intervention consisted of case study sessions and the implementation of the nurse-initiated pain management protocol. The outcomes were assessed based on the Numeric Rating Scale (NRS) pain scores, the pain management satisfaction questionnaire, the nursing performance checklist and the waiting time evaluation form. Results: The mean pain intensity 30 and 60 min after triage and at discharge decreased significantly in the post-intervention group (p < .001). The patients' satisfaction with pain management (p < .01) and the nurses' performance (p < .001) improved in the post-intervention group. Waiting time: there was a significant reduction in the post-intervention group from the end of triage by the nurse to the visit by the physician, and from patient's arrival in ED to discharge or transferring, and also the time to initial analgesic. Conclusions: Education based on case study and the implementation of the nurse-initiated pain management protocol resulted in a significant increase in multimodal analgesia administration and a reduction in pain intensity, an increase in patient satisfaction, an improvement in the triage nurses' performance and the reduction of potential delays in pain management while maintaining the safety of patients with musculoskeletal trauma. (C) 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.