Improving the Use of Regular Analgesia in Patients Admitted Post-Fall: A Quality Improvement Project

Background: Pain management following falls is frequently inadequate, especially in non-verbal or cognitively impaired patients. Poor analgesia can contribute to worsened delirium, delayed mobilisation, and longer hospital stays. This project aimed to evaluate and improve the use of regular analgesia in such patients.

Methods: Over three audit cycles, we reviewed 20 consecutive patients per cycle admitted with falls or collapse over 96-hour periods. Data collected included age, sex, analgesia regimen (regular, PRN, or none), and verbal status. After cycle one, interventions such as educational posters and a teaching session were implemented.

Results:

• Cycle 1: Only 4 of 20 patients were on regular analgesia; 5 non-verbal patients received PRN or no analgesia.
• Cycle 2: Post-intervention, regular prescribing improved. Only 2 non-verbal patients lacked regular analgesia.
• Cycle 3: Of 20 patients, 2 patients were PRN/no analgesia and non-verbal. There was a rise in patients receiving regular analgesia, particularly among the elderly.

A local staff survey showed 63% would prescribe regular analgesia post-fall. Reported barriers included perceived patient autonomy (15%), forgetfulness (8%), and reliance on injury severity (8%). Suggested improvements included electronic alerts (36%) and pharmacist involvement (27%).

Literature supports this initiative: The Society of Hospital Medicine links poor pain control with prolonged hospitalisation and higher readmission rates. A 2015 study showed pain as a common cause of readmission from skilled nursing facilities. Barriers to prescribing include bias, lack of training, and systemic issues. Interventions like decision support systems and audit feedback have been shown to improve pain management documentation.

Conclusions: Educational interventions improved analgesia prescribing, particularly for non-verbal patients. Continued education and systemic prompts (e.g., pharmacist input, electronic alerts) may enhance adherence to pain management best practices and reduce length of stay.