Long-Bone Fracture Pain Management in the Emergency Department

Published:March 24, 2011DOI:https://doi.org/10.1016/j.jen.2010.11.001

      Introduction

      The purposes of this study were to investigate the adequacy of pain management for patients with long-bone fractures seen in the emergency department and to determine whether racial disparities exist.

      Methods

      The design was an exploratory, correlational design using patient data abstract ed from electronic medical records of 2 major urban medical centers located in the Southeastern United States. Data collected included demographics, time of initial pain assessment by the registered nurse, time of pain medication administration, severity of pain, fracture location by radiograph, type of pain medication, and route-dosage of pain medication administered. The primary outcome variable, which was the pain management index, was calculated and used as a measure of adequate pain management.

      Results

      The majority of the sample (N = 218) was female (61%) and white (63%), with 28% black and about 10% of the sample consisting of other minorities. Seventy-nine (36%) of the 218 patients received no medication while in the emergency department despite a mean pain score of 6.9 (SD = 2.5) on a 0 to 10 scale representing moderate to severe pain. Patients who received pain medication (n = 126) waited for the medication 1.76 hours (±1.47). Among the patients who received an analgesic (n = 126), younger patients, black patients, and those with higher pain severity were more likely to receive inadequate pain management than were white patients.

      Discussion

      According to the pain management index, the majority of the patients in this study received inadequate pain management while in the emergency department. Future interventions may need to focus on giving ED nurses information about inadequate pain management and disparities in pain management in the ED setting and exploring possible reasons for disparities in order to ultimately improve patient care.

      Key words

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      Biography

      Ptlene Minick is Associate Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA.

      Biography

      Patricia C. Clark is Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA.

      Biography

      Jo Ann Dalton is Emerita Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.

      Biography

      Eva Horne is Clinical Assistant Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA.

      Biography

      Debbie Greene is Associate Professor of Nursing, Macon State College, Macon, GA.

      Biography

      Monica Brown is Assistant Professor of Nursing, Macon State College, Macon, GA.