Effective pain management in recently discharged adult trauma patients: Identifying patient and system barriers, a prospective exploratory study

Abstract

Aims and objectives: To identify barriers to adherence with prescribed analgesic regimens in recently discharged trauma patients.

Background: Trauma pain severely interferes with the life of healthy and often working individuals with intense and enduring pain experienced at home following discharge. The reasons for this are unclear considering discharge information (including discharge referral letters and nursing discharge checklists) and analgesics (scripts and/or medication) are routinely provided to patients at hospital discharge.

Design: A prospective exploratory study.

Methods: Between July-December 2014, 82 recently discharged adult trauma patients completed a questionnaire about their injury-related pain and pain management experiences posthospital discharge from a level one trauma centre. For 77 of these participants, medical records were reviewed for documentation regarding pain, analgesic consumption and hospital discharge processes.

Results: Sixty-five participants (84%) consumed opioids prior to discharge, with two-thirds (65%) of these participants given a script for and/or opioid medication at hospital discharge. Of the 77 participants who took analgesics following discharge, 26 (34%) indicated they had experienced side effects and 16 (21%) used pain medication not prescribed by a doctor. Whilst it was documented that discharge letters were given to 25 participants (32%) at discharge and 13 participants (17%) had completed nursing discharge checklists, these participants reported the lowest pain severity and interference scores postdischarge.

Conclusions: Insufficient information and analgesics given to trauma patients at hospital discharge and inconsistent and incomplete discharge processes fail to equip trauma patients to effectively manage their pain at home.

Relevance to clinical practice: It is crucial that nurses and other healthcare professionals are aware of and actively contribute to correct and complete discharge processes. Effective patient and hospital facilitators can contribute to good pain management practices amongst recently discharged trauma patients, which will thereby improve the functional outcomes of this patient population.

Keywords: analgesic barriers; inadequate hospital education; incomplete hospital documentation; injury pain management; posthospital discharge; trauma.