ABSTRACT
BACKGROUND: Inpatient pain management order sets are an important and necessary tool for standardizing and enhancing pain management for patients with traumatic injury. The purpose of this study was to assess the impact of revised inpatient pain management electronic order sets on opioid usage for patients with significant chest wall trauma. METHODS: A retrospective pre-post study was conducted for adult patients with 3 or more rib fractures admitted to the hospital at a Level 1 trauma center. Two periods were compared: 1 year prior to the order set changes and the period immediately after the revisions were implemented. Differences between medians were assessed using Kruskal-Wallis test by ranks, and differences between nominal variables were assessed with χ test. RESULTS: Twenty-five patients were analyzed for each period. There was no significant change between periods in the total amount of opioid received per day. There was a significant reduction in intravenous (IV) opioid use on the general inpatient floor (61% vs. 24%, p = .01), as well as in the percentage of patients who received IV opioid within 24 hr of discharge (40% vs. 4%, p = .002). CONCLUSION: Revised inpatient pain management order sets did not reduce overall opioid usage in a population of patients with 3 or more rib fractures. However, significant improvements were noted in decreased IV opioid usage on the general inpatient floors and within 24 hr of patient discharge from the hospital.
Subject(s)
Analgesics, Opioid , Rib Fractures , Adult , Electronics , Humans , Pain Management , Retrospective StudiesABSTRACT
There are inherent difficulties in assessing and managing pain in elderly trauma patients, especially those with chronic health conditions or diminished capacities for self-reporting pain. This retrospective study identifies and describes patterns of pain assessment for a trauma population of older adults (age ≥65 years). Gaps between patient assessments existed in all phases of hospitalization and did not meet hospital guidelines for frequency of assessment. In addition, assessment methods were not always appropriate for the patient population. We conclude that older patients were not assessed for pain frequently enough, and that more regular and routine pain assessments may improve patient outcomes.
Subject(s)
Pain Management/methods , Pain Measurement/methods , Pain/diagnosis , Wounds and Injuries/complications , Aged , Aged, 80 and over , Cohort Studies , Female , Geriatric Assessment/methods , Humans , Iowa , Male , Nursing Diagnosis/methods , Pain/etiology , Pain/nursing , Patient Satisfaction/statistics & numerical data , Retrospective Studies , Risk Assessment , Severity of Illness Index , Trauma Centers , Treatment Outcome , Wounds and Injuries/diagnosis , Wounds and Injuries/therapyABSTRACT
The purpose of the study was to determine the impact of a nurse-driven mobility protocol on functional decline. A nonequivalent control group design was used; the independent variable was mobility protocol and dependent variables were functional status and length of stay. Older adults who participated in a mobility protocol maintained or improved functional status and had a reduced length of stay. Practice implications include an emphasis on ambulation in hospitalized older adults.
