Actions to improve documented pain assessment in adult patients with injury to the upper extremities at the Emergency Department A cross-sectional study

Background: Pain is one of the most common symptoms in the Emergency Department (ED) and is the cause of more than half of the visits to the ED. Several attempts to improve pain management have been done by using, for example, standards/guidelines and education. To our knowledge no one has investigated if and how different actions over a longitudinal period affect the frequency of pain documentation in the ED. Therefore the aim of this study was to describe the frequency of documented pain assessments in the ED. Method: A cross-sectional study during 2006-2012 was conducted. The care of patients with wrist/arm fractures or soft tissue injuries on upper extremities was evaluated. Result: Despite various actions our result shows that mandatory pain assessment in the patient's computerized medical record was the only successful intervention to improve the frequencies of documentation of pain assessment during care in the ED. During the study period, no documentation of reassessment of pain was found despite the fact that all patients received pain medication. Conclusion: To succeed in increasing the frequency of documented pain assessment, mandatory pain rating is a successful action. However, the re-evaluation of documented pain assessment was nonexisting. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

The use of opioids at the end of life: the knowledge level of Dutch physicians as a potential barrier to effective pain management

<p>Abstract</p> <p>Background</p> <p>Pain is still one of the most frequently occurring symptoms at the end of life, although it can be treated satisfactorily in most cases if the physician has adequate knowledge. In the Netherlands, almost 60% of the patients with non-acute illnesses die at home where end of life care is coordinated by the general practitioner (GP); about 30% die in hospitals (cared for by clinical specialists), and about 10% in nursing homes (cared for by elderly care physicians).</p> <p>The research question of this study is: what is the level of knowledge of Dutch physicians concerning pain management and the use of opioids at the end of life?</p> <p>Methods</p> <p>A written questionnaire was sent to a random sample of physicians of specialties most often involved in end of life care in the Netherlands. The questionnaire was completed by 406 physicians, response rate 41%.</p> <p>Results</p> <p>Almost all physicians were aware of the most basal knowledge about opioids, e.g. that it is important for treatment purposes to distinguish nociceptive from neuropathic pain (97%). Approximately half of the physicians (46%) did not know that decreased renal function raises plasma concentration of morphine(-metabolites) and 34% of the clinical specialists erroneously thought opioids are the favoured drug for palliative sedation.</p> <p>Although 91% knew that opioids titrated against pain do not shorten life, 10% sometimes or often gave higher dosages than needed with the explicit aim to hasten death. About half felt sometimes or often pressured by relatives to hasten death by increasing opioiddosage.</p> <p>The large majority (83%) of physicians was interested in additional education about subjects related to the end of life, the most popular subject was opioid rotation (46%).</p> <p>Conclusions</p> <p>Although the basic knowledge of physicians was adequate, there seemed to be a lack of knowledge in several areas, which can be a barrier for good pain management at the end of life. From this study four areas emerge, in which it seems likely that an improvement can improve the quality of pain management at the end of life for many patients in the Netherlands: 1)palliative sedation; 2)expected effect of opioids on survival; and 3) opioid rotation.</p

Trainers' Attitudes towards Cardiopulmonary Resuscitation, Current Care Guidelines, and Training

Peer reviewe

Potilasturvallisuuteen liittyvät asenteet ja käsitykset muodostuvat lääketieteen opiskelijoilla jo varhain

Tiivistelmä Lähtökohdat: Potilasturvallisuuden kehittäminen edellyttää työelämään siirtyvien opiskelijoiden asenteisiin vaikuttamista. Tämän tutkimuksen tavoitteena oli selvittää, millaisia käsityksiä, tietoja ja asenteita oli potilasturvallisuudesta. Menetelmät: Vuosina 2016–2018 Oulun lääketieteellisen tiedekunnan kolmannen vuoden opiskelijat täyttivät vapaaehtoisen kyselylomakkeen, joka sisälsi 22 potilasturvallisuuteen liittyvää väittämää. Vastausvaihtoehdot olivat 1–5 (1 = täysin eri mieltä, 5 = täysin samaa mieltä). Tulokset: Täytetyn lomakkeen palautti 153/417 (36,7 %) opiskelijaa. Heistä 96,7 % piti potilasturvallisuutta sekä avointa ilmapiiriä tärkeinä. 96,1 % piti virheitä väistämättöminä, ja 73,4 % ajatteli lääkärien toiminnan voivan vaikuttaa virheiden syntyyn. Opiskelijoista 96,7 % aikoi työskennellä huolellisemmin virheen tapahduttua. Varhaisen potilasturvallisuuteen liittyvän opetuksen suurempi määrä oli yhteydessä myönteisiin asenteisiin potilasturvallisuutta kohtaan. Päätelmät: Opiskelijoiden asenteet näyttävät kehittyneen prekliinisessä vaiheessa ilman tietoista opetusta. Opetuksen suunnittelussa tulee panostaa pitkällä aikavälillä tapahtuvaan jatkuvaan oppimiseen opintojen alusta lähtien.Abstract Medical students’ knowledge and perceptions about patient safety develop in the preclinical years Background: To improve patient safety culture, the attitudes of graduating medical students need to be influenced. The purpose of this study was to find out what kind of perceptions, attitudes and knowledge medical students had about patient safety before they received education on the subject. Methods: From 2016 to 2018, third-year medical students from the University of Oulu filled in a voluntary questionnaire consisting of 22 questions related to patient safety. All survey questions utilized a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results: The questionnaire was returned by 153 of 417 students (36.7%). Evaluation of the questionnaires showed that 96.7% of students considered patient safety and an open workplace environment to be important, 96.1% thought errors were inevitable, 73.4% thought that doctors were able to prevent medical errors by their own actions at work, and 96.7% of students planned to pay more attention at work after having experienced medical errors. There was a positive correlation between received patient safety education and positive attitudes towards patient safety. Conclusions: The findings of this study suggest that medical students’ attitudes towards patient safety develop before they receive education about the subject in their clinical studies. Continuous learning about patient safety should be emphasized in teaching throughout medical school, and it should be considered when developing new curricula