Emergency medicine journal : EMJ
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Pain presents regularly in a range of medical and traumatic conditions. Ongoing monitoring for STEMI, limb fractures and major trauma, as well as audits on paediatric care have all indicated, however, that adequate pain management is not yet universal. Involvement in the ASCQI project demonstrated the benefits of using QI methods to engage with clinicians, to identify barriers to providing evidence-based care and possible solutions. A QI approach was thus employed to tackle obstacles to optimal pain management, as part of the ASCQI Impact study. ⋯ The Clinical Webchat is a novel QI method that can engage geographically-dispersed clinicians on a pre-prepared topic. Useful, generalisable information, added to audit findings, informed recommendations that could provide real and sustained improvements in patients' experience.
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Pain affects 4 out of 5 patients presenting to ambulance services and is often poorly assessed and treated. Currently, patients' pain is assessed by ambulance clinicians using a numerical verbal (zero to ten) pain score (NVPS). Our previous qualitative study showed that NVPS were poorly understood by patients and that a better pain assessment tool was needed. This current study sought to develop and test a novel pain assessment tool 'Patient Reported Outcome Measure for Pain Treatment (PROMPT)' for feasibility of use by ambulance paramedics. ⋯ Preliminary findings suggest that PROMPT is reliable, feasible to use, and has face, content and predictive validity. In order to evaluate the effectiveness of the tool, we are conducting a non-randomised control group study comparing pain management provided by paramedics using the tool with paramedics following their usual practice.
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Care for older people with dementia (OPWD) is a major concern across all care settings. Ambulance services are in the spotlight as pressures on emergency services and calls for admission avoidance are policy priorities. Around 1/3 of emergency call-outs are to people 75 and over, a significant proportion of whom may have dementia. There is a perception that dementia may be an issue but we do not understand how much this affects use of emergency services. ⋯ There is little current research that understands what ambulance clinicians are doing with respect to caring for OPWD. Research questions should focus on how communication between the person with dementia, formal/informal carers, healthcare professionals and emergency services affects the care provided for older people with dementia during and immediately after urgent care events.
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- Accepted for publication in Journal of Paramedic Practice.