A PROTOCOL TO IMPROVE ANALGESIA USE IN THE ACCIDENT AND EMERGENCY DEPARTMENT

Objective-To assess the use of analgesia in an accident and emergency (A&E) department and identify shortcomings. Setting-University teachin g hospital. Methods-An audit of patients referred from the A&E departm ent to orthopaedic fracture clinic (n = 100) or for orthopaedic admiss ion (n = 100) was carried out to document analgesia use. An analgesia protocol was introduced and analgesia use was reassessed on the same n umbers of patients. Results-Prescribing of analgesia was initially poo r: 91% of fracture clinic referrals and 39% of admissions received no analgesia while in the A&E department; when given, it was often by ina ppropriate routes. Introduction of an analgesia protocol significantly improved analgesia use: fracture clinic referrals receiving unsatisfa ctory analgesia were reduced from 91% to 69% (P<0.001). There was a ma rked increase in the use of intravenous analgesia, from 9% to 37% (P<0 .001). Conclusions-Large numbers of patients still receive no analgesi a while in the A&E department. This seems to be a common problem requi ring intervention at a national level. The absence of a coordinated ap proach to improving analgesia provision for acute trauma in the United Kingdom should be addressed urgently.