Members and trainees are being encouraged to have their say on the use of patient controlled analgesia (PCA) devices in emergency departments.
The opportunity to provide feedback forms part of a research project into PCA devices being conducted by PhD Candidate Natasya Raja at The University of Notre Dame. She is being mentored by FACEM Professor Ian Rogers who works at St John of God Murdoch Hospital.
The aim of the project is to assess the feasibility of PCA devices in the emergency department environment.
Focusing on the patient experience
Professor Rogers says the project started as a quality improvement exercise. “We wanted to pick a theme for the department that focused on the patient experience,” he says. “We actually launched it under a banner called ‘your pain, our priority’.
“We wanted it to be more than just a quality improvement exercise. We wanted it to be something we could explore academically, both in terms of education and research.
“It’s been a multi-faceted, multi-year program.
“We started a nurse-directed analgesia protocol, trying to improve the quality of pain assessment and pain management, we have other people exploring other aspects, for example the use of acupuncture as pain relief.
“This project relates to the same thing – can we do better in terms of treating patients’ pain because we know that when patients are satisfied with the analgesia they receive they are actually satisfied with the care they receive. The two are intimately linked.”
What is pain?
According to , pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
Most studies suggest that pain is the primary presenting problem, or an important secondary problem in 6 or 7 out of 10 of every patient who presents to an emergency department.
Professor Rogers says: “It’s a very personal experience. Again, with this study we wanted to focus on something associated with the patient experience.”
Looking at PCA use
A PCA device delivers a pre-determined dose of intravenous opioid analgesia to a patient experiencing moderate to severe pain when the patient pushes a button. They are commonly used in hospitals including with post-operative patients and in orthopaedic wards and general surgical wards, but are not usually used in the emergency department.
“Natasya is trying to work out what are the barriers, what are the issues that people see that are stopping them using PCA,” Professor Rogers says.
“When you consider how many people with pain we are dealing with, it is a surprise to us that we are not seeing PCA used more commonly in emergency departments.”
When asked why they have not been deployed in emergency departments, Professor Rogers suspects there are a number of reasons. “It may be the equipment hasn’t been provided in the emergency department, it might be that staff haven’t had the necessary education, there are probably some misconceptions among staff about how much time is required to set up a PCA and get it running, and I wonder if there are concerns about giving patients control when traditionally we’ve sort of titrated pain relief at the bedside,” he says.
“I suspect there are a whole host of factors both educational, technical, attitudinal that are, one way or another, acting as barriers.”
Nevertheless, Professor Rogers is a believer in PCA. “If it is OK to use it in an acute orthopaedic ward – which is a much lower acuity area than an emergency department – why can’t it be appropriate and OK to use in an emergency department where we’ve got such highly trained nurses and doctors and where we’ve got close supervision and observation of patients,” he says.
“The big thing about PCA, apart from its proven efficacy in those other settings, is that it is giving patients that control, and giving patients control of things usually improves their satisfaction.”
System solutions
Professor Rogers says this study is an example of emergency medicine being “the system problem-solver”.
“We look at systems and ask ourselves ‘how do we make it work better for the patients rather than just looking at a particular disease, drug, antibiotic, or treat a particular infection,” Professor Rogers says.
“I see the use of PCAs as one of those system questions – is there something different we can do in the system and, as a consequence, would lead to better pain relief for our patients and therefore better satisfaction?”
Start the survey
The survey, which will take 5 minutes to complete, is open until mid-April.
Following the survey, further studies will be undertaken to develop a trial protocol for a formal clinical trial of the use of PCA in an Australasian emergency department setting.
“Completing the survey itself might provoke some other emergency departments to ask the question ‘gee, why don’t I use PCAs in my department, can I do it already, do we already have the resources’. So, sometimes this sort of research in itself provokes change before you have the results,” Professor Rogers says.
