A quality control program for acute pain management in out-of-hospital critical care medicine

Study objective: This study was conducted to evaluate a quality control pro gram for improving pain treatment in the out-of-hospital setting. Methods: Pain was evaluated for all patients at the beginning (T-0) and the end (T-end) of out-of-hospital management. During the first part of the st udy (part 1, n=108), the administration and choice of analgesics was left t o the physician's discretion. Pain protocols were then modified to encourag e the use of opioids. The effectiveness of this new pain management was ana lyzed (part 2, n=105) using pain scales and quality of relief. Results: Seventy percent of patients who expressed meaningful pain did not request analgesia, and 36% did not receive any analgesia in part 1 in contr ast to 7% in part 2 of the study. The verbal rating scale and visual analog scale scores were substantially improved at T-end Versus T-0 in both perio ds, but the improvement was greater in part 2 (mean visual analog scale sco re at T-end was 29.3 +/- 23 mm [+/- SD]) than in part 1 (38.6 +/- 25 mm). T he percentage of patients who expressed satisfactory relief increased in pa rt 2 (67% versus 49% in part 2). The mean dose of intravenous morphine was 7.2 +/- 6 mg. Adverse effects were rare and minor. Conclusion: This program focusing on pain treatment plus implementation of pain protocols (with intravenous morphine) improved pain management in the field.