Within Sixty Is Nifty: Improving Long-Bone Fracture Pain Management Outcomes
Handout (1.3 MB)
As Emergency Department (ED) nurses addressing quality, we wanted to improve the indicator "Median time to Pain Management for Long-bone fractures (LBF)". An improvement team was selected in August 2013 to meet the goal of 60 minutes or less from door arrival to delivery of pain medication.
Relevance/Significance:
The median time to pain management for long-bone fractures (LBF) is reviewed monthly. The threshold of 86 minutes was consistently being met but not the target of 60 minutes. In July 2013, the median time had increased to 103 minutes. As Emergency Department nurses addressing quality, we wanted to improve this indicator and meet the goal of 60 minutes or less from door arrival to delivery of pain medication for long-bone fractures.
Strategy and Implementation:
Identifiable barriers and ideas for change came from the staff. Nurses were reluctant to medicate patients at triage. The pain protocol policy concerns were addressed. In conjunction with risk management, a documentation statement and script were developed. The barrier of medicated patients present in the waiting room was tackled next. Recent triage renovations along with mirror installation, allowed for visualization of waiting patients. Our team wanted to be proactive with the sixty minute pain medication reassessment. A white dry erase board was installed for easy identification of those who received pain medication and needed to be reassessed. Next barrier addressed by the team, was sustainability. The ED Quality Nurse sent out daily emails to physicians and nurses that included if the indicator was met or if an opportunity was missed. Our long bone champions were recognized daily at huddles and they also received recognitions for their badges in the shape of a bone.
Evaluation:
One year later (July 2014), our median time to pain medication was 25 minutes.
Implications for Practice:
Emergency departments need to share collaborative strategies that will assist improving pain management for this population. Breaking down barriers, weekly staff recognition, badge recognition, and celebrating accomplishments are important strategies that worked with this initiative.