Pre-hospital pain assessment and management: a quality improvement (qi) approach.

BACKGROUND: Pain presents regularly in a range of medical and traumatic conditions. Ongoing monitoring for STEMI, limb fractures and major trauma, as well as audits on paediatric care have all indicated, however, that adequate pain management is not yet universal. Involvement in the ASCQI project demonstrated the benefits of using QI methods to engage with clinicians, to identify barriers to providing evidence-based care and possible solutions. A QI approach was thus employed to tackle obstacles to optimal pain management, as part of the ASCQI Impact study.

METHOD: Trust clinicians were invited to join a Clinical Webchat, an online forum, to discuss pain assessment techniques and pain relief, including non-pharmacological methods. Clinicians shared their experiences and suggestions, and were guided by questions using audit evidence to provoke discussion. A thematic analysis of the Webchat transcript informed recommendations for clinical managers and trainers.

RESULTS: 11 clinicians took part in the Webchat, with representation from the Clinical Development and Audit teams. Participants agreed with the value of the existing pain scales to assist in titrating pain relief interventions. However, concerns that patients may over-estimate their pain meant clinicians use supplementary observations. Potential alternative methods were suggested for assessing pain. Practical issues with Entonox were uncovered, and the adequacy of the current formulary was questioned. It was accepted that non-pharmacological techniques were often overlooked, and innovative suggestions around use of distraction and combining analgesia with immobilisation emerged. Recommendations included publicity around overlooked techniques; auditing pain management for specific groups; tackling localised and practical barriers to providing exemplary care; and further QI work exploring complementary pain assessment methods.

CONCLUSION: The Clinical Webchat is a novel QI method that can engage geographically-dispersed clinicians on a pre-prepared topic. Useful, generalisable information, added to audit findings, informed recommendations that could provide real and sustained improvements in patients' experience.