Improving Initial Management of Acute Musculoskeletal Pain in the Emergency Department

Author

Cynthia Y. Norris, The University of Texas at El Paso

Date of Award

5-2024

Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)

Department

Nursing

Chair

Sondra Skory

Abstract

Background/Problem Statement: Acute musculoskeletal pain is one of the major chief complaints amongst Emergency Department (ED) visits each year. In the United States, approximately 41.9 million annual ED visits are musculoskeletal pain related (Fontánez, et al., 2021). Yet, data statistics demonstrate at least 40% of patients reported their pain remained unchanged during their presentation to an ED (Bussey et al., 2020).

Aims/Methods: At University Medical Center, site of the quality improvement project, a total of 91,455 ED annual visits were reported in the latest data reports (El Paso County Hospital District 2022 Annual Report, 2022). This paper chronicles the implementation of an evidenced based practice quality improvement project using the Plan-Do-Study-Act (PDSA) model, which focused on improving patient pain scores upon presentation into triage in the ED. Patients were initially selected during presentation through the triage process. Candidates met criteria if they were 18-55 years of age, with no history of renal, bleeding disorders, or serious comorbidities, presenting with acute musculoskeletal pain within an onset of less than 48 hours. Pain scores were measured via subjective numeric pain scoring scales, (1- 10), with 1 as minimal pain and 10 as the most severe pain. Patients with pain scores greater than 4 were treated with a combination of intramuscular Toradol (ketoradol) and oral Flexeril (cyclobenzaprine). The combination of these two medications targets musculoskeletal pain in two ways, by utilization of; 1.) a nonsteroidal anti-inflammatory drug (Toradol) to decrease pain and inflammation and, 2.) a muscle relaxant (Flexeril). Utilizing a numeric pain scoring scale of 1 through 10, each patient’s pain level was assessed before treatment and 30 minutes after treatment intervention.

Results: A total of 20 patients met criteria for the project. 14 patients reported their pain had significantly improved by at least a 3-point reduction after intervention.

Conclusion/Implications: Project implementation outcomes demonstrated that at least 70 percent of patients who met project criteria benefited from the proposed quality improvement project. Implications for future practice demonstrate an effective pain control intervention which can potentially minimize pain levels in many patients, and ultimately decrease ED length of stay times, improve patient perceptions and satisfaction.

Recommended Citation

Norris, Cynthia Y., "Improving Initial Management of Acute Musculoskeletal Pain in the Emergency Department" (2024). Cohort XII. 2.
https://scholarworks.utep.edu/cohort_12/2