Patients’ and emergency clinicians’ perceptions of improving pre-hospital pain management: a qualitative study

Iqbal, Mohammad, Spaight, Anne and Siriwardena, A. Niroshan (2013) Patients’ and emergency clinicians’ perceptions of improving pre-hospital pain management: a qualitative study. Emergency Medicine Journal, 30 (3). e18. ISSN 1472-0205

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Patients’ and emergency clinicians' perceptions of improving prehospital pain management: a qualitative study
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Background: The authors aimed to investigate patients' and practitioners' views and experiences of pre-hospital pain management to inform improvements in care and a patient-centred approach to treatment.
Methods: This was a qualitative study involving a single emergency medical system. Data were gathered through focus groups and semi-structured interviews. Participants were purposively sampled from patients transported by ambulance to hospital with a painful condition during the past 6 months, ambulance service and emergency department (ED) clinicians. Interviews were audiotaped, transcribed and thematic analysis was conducted.
Results: 55 participants were interviewed: 17 patients, 25 ambulance clinicians and 13 ED clinicians. Key themes included: (1) consider beliefs of patients and staff in pain management; (2) widen pain assessment strategies; (3) optimise non-drug treatment; (4) increase drug treatment options; and (5) enhance communication and coordination along the pre-hospital pain management pathway. Patients and staff expected pain to be relieved in the ambulance; however, refusal of or inadequate analgesia were common. Pain was commonly assessed using a verbal score, but practitioners' views of severity were sometimes discordant with this. Morphine and Entonox were commonly used to treat pain. Reassurance, positioning and immobilisation were used as alternatives to drugs. Pre-hospital pain management could be improved by addressing practitioner and patient barriers, increasing available drugs and developing multi-organisational pain management protocols supported by training for staff.
Conclusions: Pain is often poorly managed and undertreated in the pre-hospital environment. The authors' findings may be used to inform guidance, education and policy to improve the pre-hospital pain management pathway.

Additional Information:First published online April 2012
Keywords:prehospital, ambulance, paramedic, quality improvement, pain, analgesia
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
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ID Code:5185
Deposited On:05 May 2012 12:56

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