Comparison of multimodal, sliding scale acute pain protocols with traditional prescribing in non-surgical patients
Pawasauskas J, Kelley M, Gill C, and Facente M. Comparison of multimodal, sliding scale acute pain protocols with traditional prescribing in non-surgical patients. Postgrad Med 2019.
OBJECTIVE: Our institution implemented six multimodal, sliding scale protocols for managing pain in non-surgical inpatients. The purpose of this study was to compare the use of these acute pain protocols with traditional prescribing in regard to pain management efficacy and safety measures. METHODS: This retrospective cohort study evaluated hospital in-patients who were prescribed one of the protocols during the first six months following implementation, admitted to the hospitalist service, and had received at least two doses of PRN analgesic medication within a 24-hour period. Data collected included baseline demographics, verbal pain rating scores to determine time to achieve analgesia, total opioid use in oral morphine equivalent doses (MEDs), and safety measures. A sample of patients admitted during the same time frame, meeting inclusion/exclusion criteria, but who received traditional analgesic prescribing served as controls. RESULTS: Forty-six adult, non-surgical patients were included in the analysis, and 46 served as controls. The average baseline pain scores were similar between groups (7.26 in protocol, 7.43 in control, p=0.684). Protocol patients required significantly less time to achieve meaningful analgesia (average 507.52 minutes) compared to the control group (894.33 minutes, p=0.045). Patients in the protocol group used an average of 35.81 MEDs per day compared to 65.77 MEDs in controls (p=0.019). Patients in the protocol group used significantly fewer PRN analgesic doses (12.70 vs. 24.02, p<0.0001). CONCLUSION: Analysis of the implementation of acute pain management protocols indicate that using standardized pain management protocols of opioids, non-opioids, and medications to prevent opioid-related adverse events is more effective than traditional analgesic prescribing for our patient population.
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