Improving Time Management of Pain Administration in ER for Fractured Bones - Research Proposal Example

IMPROVING TIME MANAGEMENT OF PAIN ADMINISTRATION IN ER FOR FRACTURED BONES Purpose The purpose of this research proposal is tofacilitate a better clinical medical practice in relation to an improvement in time management of pain administration In ER for fractured bones. Time is one of the key factors necessary for fractures treatments in clinical evidence based practices. This is because in most cases, the patients suffering from multiple fractures may easily succumb due to excessive pain. It is therefore necessary to improve time management in the casualty department of hospitals by attending fractured patients within the minimum time possible. In a general overview, the purpose of this research is to compare extensively the outcomes and time required for the implementation of pain management protocols for in-patients or outpatients admitted to the emergency department with bone dislocations or even fractures. This research paper is therefore a statement overview of a better policy implementation aimed at reducing deaths arising because of laxity verses treatment time to the fractures patients. Problem statement Patients presented to the emergency casualty department in most cases suffer from fractured bones. The patients presented in the emergency rooms therefore portray a potentiality or obvious dislocations or fractures. These medical conditions are in most clinical practices faced with many delays in pain medication attendance with the current protocols recommending for labs and radiology as the first priority. Most clinics or hospitals lack both the laboratories necessary for fractures treatment and radiology. This has therefore led to the over-reliance on therapeutic approach for the treatment of dislocations and fractures. Per se, therapeutic approach in fractures treatment is time consuming and only advisable for mild external dislocations and fractures. It is therefore necessary for the hospitals to get more time-oriented clinically based mechanisms for treating fractures patients in the emergency rooms (Bennets et al., 2012). The current nursing interventions aimed at curbing the delays experienced in fractures treatments include; checking pulses, covering open fractures, elevating, immobilizing and ice application. Nonetheless, hip, pelvic and bone fractures are extraordinarily difficult to elevate, maintain icepacks and painful in diagnosis for the clients’ during the examination stage. Accordingly, the only way to reduce such pain to the fractures paints in hospitals in the improvement of time management for these patients’ treatment schedule. Implementation of a pain management protocol would improve the patients’ comfort and the amount of time needed for the definitive treatments inclusive of splinting, realignment and the overall patients’ satisfaction. The sensitive aspects of bone dislocations or fractures include the musculoskeletal injuries. Musculoskeletal injuries medically include strains, sprains, dislocations and fractures. Adjustments in bones, muscles and joints in most fractures are caused by an acute trauma. Trauma and pain in fracture patients is the leading cause of their deaths. These deaths are evident across the people of ages of one year old to 44 years of ages of all races and socio-economic status. In close clinical view therefore, time management of pain is therefore a vital requirement in fractured bones treatment. What Is A Fracture? A fracture refers to a break in the bone continuity that occurs when an exceeding force is applied to the bone tensile or the overall compressive elastic limit of the bone. The highest incidences of bone fractures occur to the males of between 15-24 years and in adults of 65 years and above. This gives the casualty departments a benchmark point of planning adequately for the overall management of bone fractures. The males of 15-24 years are in most cases found to be vulnerable to bone fractures psychologically due to the excessive energy availability at this ages. At the ages of 15-24 years of age people tend to take part in various risky activities due to a lot of energy production which tend to put them at a higher risk of getting bone fractures (Kumle et al., 2013). At the ages of 65 years and above on the other hand fractures are experienced as a result of elasticity in the growth and development. At this age there is no bone formation, limited energy in energy productions thus these individuals are easily exposed to bone fractures. Fractures of the clavicle, tibia and humerus are common in young adults and because of trauma. The immediate pain of a fracture in most cases is intense, followed by severe pains produced by overriding of the fracture segments, muscle spasms and the damage of the adjacent soft tissues. The management of fractures should therefore begin from a simplistic approach, which may involve home-based bone fracture education and ways to avoid being a victim of bone fractures. Review of Literature Various studies have found that the best way so far for fracture management is to use the minimal time possible to undertake fracture treatments. These studies to some extent are in opposition to the psychotherapeutic approach of bone fracture treatment. These scholarly articles argue that therapy should only be a sub or supra-structure within clinical bone fractures treatments. In an article marked minimum standards for the management of hip fracture to the older persons (65 years of age and above), the ACI, an NSW agency for clinical innovation puts time, technological and professionalism factors as the only aspects necessary for the improvement of bone fracture management in the evidence-based clinical practices (Bennets et al., 2012). Hip fractures a common dislocation in male children of ages (15-24) and elderly individuals of 65 years and above has been a common occurrence just like obesity for younger and older Australian occupants. Hip fractures in most scenarios among Australians are as result of a fall. About 17,000 cases of hip fractures are presented to the emergency departments across the country of Australia each year. Surgery to repair these fractures and rehabilitation after surgery as well as patients discharge home may be affected at large. These clinical aspects can be delayed if the medical conditions are not recognized at an early stage and managed immediately. Poor management of fractures can in return result into significant medical setbacks, ill health and in extreme cases it can result to death. The Agency for Clinical Innovation (ACI) has showcased various time versus management strategies which are ideal in the clinical health practices’ treatment and management of bone structures and dislocations. This ACI clinical agency has worked with the expert clinicians in the NSW to develop an efficient minimum standard fracture treatment guide to the healthcare providers on the ideal management strategy and care of older people with hip fractures as well as other fractures across the NSW health system. These times management structures though dwells on the older people specifically, can be applicable to even the younger generations suffering from fractures and dislocations (Golzari et al., 2014). Fracture management emphasizes on the importance of fracture treatment through a comprehensive, conglomerate and multi-disciplinary approach from presentation to the ultimate subsequent fracture treatment follow-up. The subsequent follow-up involved in fracture treatment includes the transition from hospital to community in terms of how hip or ordinary fractures patients should be nursed after their discharge. Healthcare service providers who have in one way or the other implemented the ACI guidelines in their evidence-based-clinical fracture treatments have already demonstrated some aspects of positive results in time management during the treatment bone dislocations. By taking a collaborative approach to care, optimizing patients for surgery and effectively managing pain, helping on early patients mobilization, screening for future fracture risks and ensuring the data collected can help in driving continuous improvements in patient care- they would be a commendable and significant pain reduction and complications for fracture patients. Additionally, a well-planned response in terms of time and management of fractures in hospitals improve quality of life in relation to superb outcomes to the patients after surgery. Minimum standards necessary in improving time management of pain administration in ER for fractured bones Implementation and adherence to evidence-based clinical standards would ultimately improve the care and management for patients with hip fractures in hospitals. An improved care in the emergency room/departments in hospitals will result into better outcomes such as; better functional outcomes, increased patients discharge rates to their residential places, reduction in mortality and morbidity and lastly, an increment in value from the health dollar spent. The proposed benchmark and standards for fracture management in clinical practices include orthogeriatric clinical management, optimal pain management, surgery within 48 hours and in hours (regardless of inter-hospital transfers), non-cancelation of patients surgery, commencement of mobilization within 24 hours of fracture’s surgery, local ownership of data processes or systems to drive improvement in care systems and lastly re-fracture prevention (Lemay et al., 2010). Application/significance of the management standards to the nursing practice The orthogeriatric clinical management can be implemented in many forms. Local implementation doctrines therefore vary from one hospital to the other depending on the workforce and financial positions within the orthopedic or geriatric departments. There are basically three applicable fracture management standards in the clinical practices. These management standards include; model 1 or orthogeriatric liaison/collaborative care. This model is considered one of the most efficient practice cares. It has been majorly adopted by the hospitals that do not have geriatric facilities and services available. In the collaborative fracture management care, the patients are admitted under the geriatric registrar and orthopedic surgeon with whom are integrated into the orthopedic teams to facilitate a timely collaborative fracture care (Pines & Hollander, 2008). Secondly, the registrar as per the collaborative care model is supposed to be wholly supported by orthogeriatrican. These clinical personnel in the fracture care department manage the patient care collaboratively on a daily basis with the orthopedic teams help. Lastly, the collaborative care clinical proposal concerning fractures treatment begins at admission of the patients and continues in a timely and systematic manner through the pre- and post-fractures operation periods onto the identification, referral and rehabilitation periods inclusive of secondary fractures prevention and discharge planning periods. The second model of timely fracture treatment management is the shared orthogeriatric care. This is another simple and cheaper model to implement by the fracture treatment management teams or clinicians. Under this care model, the patient is admitted under the care of both orthopedic surgeon and a geriatrician (Statements, 2010). Both services to the patients in this model involve responsibility coverage by the healthcare practitioners for both pre and post-operative multidisciplinary cares. The third and last model is the consultative orthogeriatric care. The patients in this model are under care of orthopedic team. When issues arise such as re-fracturing, timely input is advisable under this care. A geriatrician or physicians provide this timely input. Out of the above three models, the collaborative time/management care model has been explicitly used in various fracture management clinical cares. It is therefore the one of the best management models for the management of pain administration of ER in fractured bones. Quality measures for the bone fracture patients in terms of time of recovery management System measurements: System measurements are an important attribute of management and time needed for treatment of fractures’ analysis. System analysis in fracture patients involves the analysis of the patient’s progress in terms of recovery from the time of admission to surgery. System measurement is often a 30-day mortality analysis (Tanabe & Buschmann, 2000). System measurement in fracture pain administration in addition involves both the analysis of the average length of stay by the patients (acute phase) and the cancellation rates on scheduled days of surgery by the individual surgeons in hospitals. The second preferred quality measure to the fractured patients is the individual patient’s measurements. These measurements may include; time of mobilization, treatment for osteoporosis, medical complications assessments such as pressure ulcers, myocardial infarction, and DVT, pneumonia and delirium health conditions. Anesthetic management significance to nursing Anesthetics assume an integral role in nursing field especially in pain management and administration to ER fracture patients. Anesthetic plays a major role specifically in the perioperative, operative and postoperative management of hip fracture patients. In management of fracture patients where geriatric involvement is absent, anesthetic role may be fundamental in the management of hip fractures. Evidence-based practice of anesthetics management: Orthogeriatric management impacts on fractured patients has shown optimism impact to the pre-operative preparation, improvement in rehabilitation outcomes, reduction in mortality rates and decrease in post-operative complications to bone fracture patients (Oliver et al, 2012). A reverting cohort study done to investigate the impact of regular post-and pre-operative geriatric input into the management of geriatric in-patients with hip fracture in Hong-Kong city demonstrated a decrease in the following clinical attributes. Medical complications in hospitals, Mortality and reduced readmission to operation time by about 17% and lastly a reduction in the length of stay in hospitals in cases where Orthogeriatric management of a patients was effectively and efficiently undertaken in a timely manner (Stauber, 2013). Secondly, a randomized Ireland’s collaborative model care study trials showed that about 45% decrease in major complications such as delirium, DVT (deep vein thrombosis) and CCF (comprehensive classification of fractures) were easily managed in hospitals which adopted the collaborative care model of fractures treatment. Another renowned fracture treatment cohort study of a multidisciplinary approach for the treatment of hip fractures in Netherlands ideally found a significant 11% reduction in the number of readmissions within 30 days of discharge in cases where fractures were efficiently and effectively treated within the required time durations (Stanber, 2013). Lastly, a clinical trial of the collaborative Orthogeriatric model in comparison with the Australian historical population showed that there was about 21% reduction in medical complications, 20% reductions in re-admissions at six months for fractured patients and a 3% reduction in mortality (Bennetts et al., 2012). Concisely, these comparative world’s cohort studies clinically called for nursing, especially in the fracture treatment field to adopt better policies, which timely treats the patients, and relieve them from endless fracture pains. Summary Pain management for the ER fracture patients may involve the use of multi-modal pharmacological agents. These agents are the ideal pain relievers in extreme cases of pain experiences. Pain should be made in presumptions as being severe and an ongoing activity in any given bone fracture. Effective pain management in the shortest time possible is therefore the primary clinical goal for the patients suffering from fractures. Immobility caused by bone fracture pains have been greatly linked to an increased pressure ulcer to the patients, venous thromboembolism (VTE) and pneumonia. Patients who experience greater pains because of bone fractures are also at a higher risk of delirium, sleep disturbance and depressions. Additionally, these patients may have a total decrement in their response to interventions for other comorbidities. The most prominent pain management technique for pain perturbed patients include the pharmacological approach wherein paracetamol, opioids or the use of femoral nerve blocks are used to reduce such pains before the final recovery is achieved by the patients. In fracture pain control, these pains are often undertreated or poorly controlled in orthogeriatric patients due to: reluctance of the medic staffs to prescribe analgesia in frail patients, secondly these pains persist because of reluctance or inability of the bone fracture patients to request analgesia. Lastly, bone fracture pains additionally are poorly controlled due to psychological impairment of the patients, which assesses pain levels, by the medical practitioners difficult. References Bennetts et al. (2012). Pain management in Australian emergency departments. Current practice, enablers, barriers and future directions in EMA – Emergency Medicine Australasia. Golzari et al (2014). A Review: Idocaine and Pain Management inthe Emergency Department. Article in Anesthesiology and pain medicine. Kumle et al. (2013). Pain therapy in emergency medicine. Focus on emergency admissions in Anaesthesist. LeMay et al. (2010). Pain management interventions with parents in the emergency department: A randomizedtrial. Journal of Advanced Nursing. Oliver et al. (2012). American Society for Pain Management nursing position statement: pain management in patients with substance use disorders in Pain management nursing. Official journal of the American Society of Pain Management Nurses . Pines, J. & Hollander, J. (2008). Emergency Department Crowding Is Associated With Poor Care for Patients With Severe Pain. Annals of Emergency Medicine. Statements, P. (2010). Optimizing the treatment of pain in patients with acute presentations. Policy statement. Annals of emergency medicine. Stauber, M. (2013). Advanced nursing interventions and length of stay in the emergency department. Journal of emergency nursing: official publication of the Emergency Department Nurses Association. Tanabe, P, & Buschmann, M. (2000). Emergency nurses knowledge of pain management principles. Journal of emergency nursing in official publication of the Emergency Department Nurses Association. Read More