• Audit of morphine administration by East Midlands Ambulance Service (EMAS)

      Winter, S.; Jootun, R. (2017-05)
      Aim For pre-hospital administration of morphine, JRCALC guidelines recommend recorded pain scores (PS) out of ten before and after use, an anti-emetic adjunct and ENTONOX provision prior to analgesic effect. This audit aimed to gain insight into how rigorously these guidelines were being adhered to in practice Methods This clinical audit examined patients who had been administered morphine by EMAS staff. Inclusion criteria were patients who had received documented oral, intravenous or intramuscular morphine within a three-month period. Those who declined morphine were excluded. Data extracted from the patient report forms included: patient demographics; documented PSs; morphine doses and routes; adjunct analgesics and use of anti-emetics. This information was used to determine how appropriately PSs, analgesic adjuncts and antiemetics were being used alongside morphine. Results There were 293 patients included in the audit. 205 (70.0%) had a PS documented before and after morphine administration; 50 (17.1%) had one documented PS and 38 (13.0%) had none. 58 (19.8%) patients received ENTONOX before the administration of morphine and 17 (5.8%) received it after morphine. 218 (74.4%) had no record of ENTONOX administration and only 100 (34.1%) patients were prescribed an anti-emetic with morphine. Conclusion There is potential for improved adherence to JRCALC guidelines through increased awareness and education. We will trial this at EMAS through staff notices followed by a re-audit in 4–6 months. Ideally, audits within other ambulance services with more patients would be undertaken for widespread quality improvement. https://bmjopen.bmj.com/content/bmjopen/7/Suppl_3/A3.3.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.9
    • Exploratory cross-sectional study of factors associated with pre-hospital management of pain

      Siriwardena, Aloysius; Shaw, Deborah; Bouliotis, George (2010-12)
    • Non-randomised control study of the effectiveness of a novel pain assessment tool for use by paramedics

      Iqbal, Mohammad; Spaight, P. Anne; Kane, Ros; Asghar, Zahid; Siriwardena, Aloysius (2016-09)
      Background Eighty percent of patients presenting to ambulance services present with pain. Pain is sometimes inadequately assessed and treated. Effective pain management can improve patient outcomes and experience. Previous qualitative research suggested that numerical verbal pain scores, usually used to assess pain in the ambulance setting, were poorly understood. We developed a new tool, the ‘Patient Reported Outcome Measure for Pain Treatment’ (PROMPT), to address this need. Initial testing showed that PROMPT had reliability and (face, content and predictive) validity. We aimed to investigate the effectiveness of PROMPT. Methods We used a non-randomised control group design in adult patients with chest pain or injury treated by intervention paramedics using PROMPT compared with control paramedics following usual practice for pain outcomes (reduction in pain score, use of analgesia). Routine data from electronic patient records were used to measure outcomes. We collected baseline rates of outcomes in patients treated by intervention and control paramedics, in a seven month period one year previously, to adjust for secular trends. The study was conducted in East Midlands Ambulance Service. We used regression analysis to compare groups for differences in pain score change and use of analgesics correcting for baseline rates and demographic differences. Results Twenty-five intervention paramedics used PROMPT (of 35 who were trained in its use) treating 300 patients over a seven month period. Data for these and 848 patients treated by 106 control paramedics were entered into SPSS and STATA12 for analysis. Mean reductions in pain score ( p<0.001) and use of analgesics was significantly greater (p<0.001) in patients managed by paramedics using PROMPT compared with those receiving usual care after adjusting for patient age, sex, clinical condition and baseline rates. Conclusion Use of the PROMPT resulted in greater reductions in pain score and increased use of analgesics compared with usual care. https://emj.bmj.com/content/emermed/33/9/e1.3.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2016-206139.7
    • Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

      Siriwardena, Aloysius; Asghar, Zahid; Lord, Bill; Pocock, Helen; Phung, Viet-Hai; Foster, Theresa; Williams, Julia; Snooks, Helen (2019-02)
    • What are the predictors, barriers and facilitators to effective management of acute pain in children by ambulance services? A mixed-methods systematic review protocol

      Whitley, Gregory; Siriwardena, Aloysius; Hemingway, Pippa; Law, Graham Richard (2018-09)
      Abstract published with permission. Introduction: The management of pain is complex, especially in children, as age, developmental level, cognitive and communication skills and associated beliefs must be considered. Without effective pain treatment, children may suffer long-term changes in stress hormone responses and pain perception and are at risk of developing posttraumatic stress disorder. Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. The aim of this review is to identify predictors, barriers and facilitators to effective management of acute pain in children by ambulance services. Methods: A mixed-methods approach has been adopted due to the research question lending itself to qualitative and quantitative inquiry. The segregated methodology will be used where quantitative and qualitative papers are synthesised separately, followed by mixed-methods synthesis (meta-integration). We will search from inception: MEDLINE, CINAHL and PsycINFO via EBSCOHost, EMBASE via Ovid SP, Web of Science and Scopus. The Cochrane Library, the Joanna Briggs Institute, PROSPERO, ISRCTN and ClinicalTrials.gov will be searched. We will include empirical qualitative and quantitative studies. We will exclude animal studies, reviews, audits, service evaluations, simulated studies, letters, Best Evidence Topics, case studies, self-efficacy studies, comments and abstracts. Two authors will perform full screening and selection, data extraction and quality assessment. GRADE and CERQual will determine the confidence in cumulative evidence. Discussion: If confidence in the cumulative evidence is deemed Moderate, Low or Very Low, then this review will inform the development of a novel mixed-methods sequential explanatory study which aims to comprehensively identify predictors, barriers and facilitators to effective pain management of acute pain in children within ambulance services. Future research will be discussed among authors if confidence is deemed High.