期刊
EMERGENCY MEDICINE AUSTRALASIA
卷 24, 期 2, 页码 136-143出版社
WILEY
DOI: 10.1111/j.1742-6723.2011.01499.x
关键词
analgesia; attitude of health personnel; emergency service; evidence-based medicine; pain; quality assurance
Objective: To explore current pain management practice in Australian EDs and identify enablers and barriers for best-practice pain management. Methods: Five focus groups and two in-depth interviews were held with ED clinical staff (n = 47) from six hospitals in three states. Participants were asked open-ended questions to determine current pain management practices, enablers and barriers to implementing best-practice pain management, and understand change in practice within the ED setting. Results: Emergency department staff identified a gap between evidence-based pain management recommendations and everyday practice. Perceived barriers to improving pain management included a lack of time and resources, a greater number of urgent and serious presentations that place pain management as a lower priority, organizational protocols and legislative issues. All groups noted difficulty in applying pain management guidelines in the context of competing priorities in the challenging ED environment. A culture of learning clinical practice from respected senior staff and peers was perceived to be a key enabler. Participants consistently expressed the view that evidence-based practice improvement should be championed by senior clinical staff, and that evidence to demonstrate the benefits of change must be presented to support the need for change. Conclusions: Effective and sustainable system change requires a strategy that is initiated within the ED, targets opinion leaders, is supported by evidence, and engages all levels of ED staff.
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