Abstract
Introduction: Acute pain is a common presentation of elderly and tends to be under-recognised and under-treated. Consequently, delayed and inadequate treatment of acute pain is known to lengthen in-hospital stay whilst reducing quality of life. Using local hospital guidelines for acute pain management in adults as gold standard, anecdotally we felt patients were not received medication as per guidance. A quality improvement project was undertaken with an aim to increase the number of patients >65 years old that received appropriate analgesia within the first 24-48 hours of presenting to the front door with acute pain by 15% within 8 months.
Methods: The study cohort composed of randomly selected patients > 65 years of age presenting to the front door with acute pain in the form of soft tissue injury, suspected/confirmed fracture. Parameters for data collection included cognitive background, pain assessment done on admission, analgesia prescribed in the first 24-48 hours and whether prescribed appropriately as directed by hospital guidelines. During the project period, the first intervention was aimed at sensitising medical staff of timely initiation and appropriate analgesia in elderly with an info graphic poster put up in the acute assessment unit and highlighted during Acute Medicine safety brief. A second intervention was directed at nursing staff regarding pain assessment on admission using a poster and emphasizing its importance during nursing handover.
Results: The percentage of patients who had pain assessment done increased from 27.8% to 75.0% during the project period. Similarly, of those prescribed analgesia, the percentage of patients prescribed appropriately rose from 66.0% to 86.8%.
Conclusion: This project has positively impacted the number of patients who received appropriate analgesia. Accurate pain assessment helped to determine choice of analgesia. Limitations include using age cut-off for elderly instead of frailty reflecting a role and need for frailty-based guidance.