Feasibility study of a novel pain assessment tool for improving prehospital pain management.

BACKGROUND: Pain affects 4 out of 5 patients presenting to ambulance services and is often poorly assessed and treated. Currently, patients' pain is assessed by ambulance clinicians using a numerical verbal (zero to ten) pain score (NVPS). Our previous qualitative study showed that NVPS were poorly understood by patients and that a better pain assessment tool was needed. This current study sought to develop and test a novel pain assessment tool 'Patient Reported Outcome Measure for Pain Treatment (PROMPT)' for feasibility of use by ambulance paramedics.

METHODS: The study was conducted in the East Midlands Ambulance Service NHS Trust. We conducted secondary analysis of an existing qualitative dataset to develop a draft tool. This was revised following an expert panel review by a group of 10 experienced ambulance clinicians to assess content and face validity. The feasibility study was conducted with participating paramedics using the tool in patients presenting with pain, to determine the feasibility, reliability and validity of PROMPT; to gather initial data on its effect on prehospital pain management comparing reduction in pain score and use of analgesia compared with a baseline period using regression.

RESULTS: Eighteen paramedics, using PROMPT, collected data on pain management from 132 patients. PROMPT had high internal consistency (>0.8). There were significant reductions in pain score (p=0.027) and significantly greater use of analgesics (p<0.001) in patients when PROMPT was used compared with baseline for paramedics involved in the study after adjusting for differences in patients' age, clinical condition and pain score before treatment.

CONCLUSIONS: Preliminary findings suggest that PROMPT is reliable, feasible to use, and has face, content and predictive validity. In order to evaluate the effectiveness of the tool, we are conducting a non-randomised control group study comparing pain management provided by paramedics using the tool with paramedics following their usual practice.