Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices.
emergency care
intravenous morphine titration
oligoanalgesia
opioids
pain management
severe pain
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
29 Oct 2021
29 Oct 2021
Historique:
received:
21
09
2021
revised:
24
10
2021
accepted:
25
10
2021
entrez:
13
11
2021
pubmed:
14
11
2021
medline:
14
11
2021
Statut:
epublish
Résumé
Intravenous (IV) morphine protocols based on patient-reported scores, immediately at triage, are recommended for severe pain in Emergency Departments. However, a low follow-up is observed. Scarce data are available regarding bedside organization and pain etiologies to explain this phenomenon. The objective was the real-time observation of motivations and operational barriers leading to morphine avoidance. In a single French hospital, 164 adults with severe pain at triage were included in a cross-sectional study of the prevalence of IV morphine titration; caregivers were interviewed by real-time questionnaires on "real" reasons for protocol avoidance or failure. IV morphine prevalence was 6.1%, prescription avoidance was mainly linked to "Pain reassessment" (61.0%) and/or "alternative treatment prioritization" (49.3%). To further evaluate the organizational impact on prescription decisions, a parallel assessment of "simulated" prescription conditions was simultaneously performed for 98/164 patients; there were 18 titration decisions (18.3%). Treatment prioritization was a decision driver in the same proportion, while non-eligibility for morphine was more frequently cited (40.6%
Identifiants
pubmed: 34768612
pii: jcm10215089
doi: 10.3390/jcm10215089
pmc: PMC8584399
pii:
doi:
Types de publication
Journal Article
Langues
eng
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