Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices

Intravenous (IV) morphine protocols based on patient-reported scores, immediately at triage, are recommended for severe pain in Emergency Departments. However, a low follow-up is observed. Scarce data are available regarding bedside organization and pain etiologies to explain this phenomenon. The ob...

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Autores principales:	Virginie Eve Lvovschi, Karl Hermann, Frédéric Lapostolle, Luc-Marie Joly, Marie-Pierre Tavolacci
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	severe pain oligoanalgesia intravenous morphine titration pain management emergency care opioids Medicine R
Acceso en línea:	https://doaj.org/article/70e67977f3da465d9bf9b4ca9345d28b
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spelling	oai:doaj.org-article:70e67977f3da465d9bf9b4ca9345d28b2021-11-11T17:42:51ZBedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices10.3390/jcm102150892077-0383https://doaj.org/article/70e67977f3da465d9bf9b4ca9345d28b2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5089https://doaj.org/toc/2077-0383Intravenous (IV) morphine protocols based on patient-reported scores, immediately at triage, are recommended for severe pain in Emergency Departments. However, a low follow-up is observed. Scarce data are available regarding bedside organization and pain etiologies to explain this phenomenon. The objective was the real-time observation of motivations and operational barriers leading to morphine avoidance. In a single French hospital, 164 adults with severe pain at triage were included in a cross-sectional study of the prevalence of IV morphine titration; caregivers were interviewed by real-time questionnaires on “real” reasons for protocol avoidance or failure. IV morphine prevalence was 6.1%, prescription avoidance was mainly linked to “Pain reassessment” (61.0%) and/or “alternative treatment prioritization” (49.3%). To further evaluate the organizational impact on prescription decisions, a parallel assessment of “simulated” prescription conditions was simultaneously performed for 98/164 patients; there were 18 titration decisions (18.3%). Treatment prioritization was a decision driver in the same proportion, while non-eligibility for morphine was more frequently cited (40.6% <i>p</i> = 0.001), with higher concerns about pain etiologies. Anticipation of organizational constraints cannot be excluded. In conclusion, IV morphine prescription is rarely based on first pain scores. Triage assessment is used for screening by bedside physicians, who prefer targeted practices to automatic protocols.Virginie Eve LvovschiKarl HermannFrédéric LapostolleLuc-Marie JolyMarie-Pierre TavolacciMDPI AGarticlesevere painoligoanalgesiaintravenous morphine titrationpain managementemergency careopioidsMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5089, p 5089 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	severe pain oligoanalgesia intravenous morphine titration pain management emergency care opioids Medicine R
spellingShingle	severe pain oligoanalgesia intravenous morphine titration pain management emergency care opioids Medicine R Virginie Eve Lvovschi Karl Hermann Frédéric Lapostolle Luc-Marie Joly Marie-Pierre Tavolacci Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices
description	Intravenous (IV) morphine protocols based on patient-reported scores, immediately at triage, are recommended for severe pain in Emergency Departments. However, a low follow-up is observed. Scarce data are available regarding bedside organization and pain etiologies to explain this phenomenon. The objective was the real-time observation of motivations and operational barriers leading to morphine avoidance. In a single French hospital, 164 adults with severe pain at triage were included in a cross-sectional study of the prevalence of IV morphine titration; caregivers were interviewed by real-time questionnaires on “real” reasons for protocol avoidance or failure. IV morphine prevalence was 6.1%, prescription avoidance was mainly linked to “Pain reassessment” (61.0%) and/or “alternative treatment prioritization” (49.3%). To further evaluate the organizational impact on prescription decisions, a parallel assessment of “simulated” prescription conditions was simultaneously performed for 98/164 patients; there were 18 titration decisions (18.3%). Treatment prioritization was a decision driver in the same proportion, while non-eligibility for morphine was more frequently cited (40.6% <i>p</i> = 0.001), with higher concerns about pain etiologies. Anticipation of organizational constraints cannot be excluded. In conclusion, IV morphine prescription is rarely based on first pain scores. Triage assessment is used for screening by bedside physicians, who prefer targeted practices to automatic protocols.
format	article
author	Virginie Eve Lvovschi Karl Hermann Frédéric Lapostolle Luc-Marie Joly Marie-Pierre Tavolacci
author_facet	Virginie Eve Lvovschi Karl Hermann Frédéric Lapostolle Luc-Marie Joly Marie-Pierre Tavolacci
author_sort	Virginie Eve Lvovschi
title	Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices
title_short	Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices
title_full	Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices
title_fullStr	Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices
title_full_unstemmed	Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices
title_sort	bedside evaluation of early vas/nrs based protocols for intravenous morphine in the emergency department: reasons for poor follow-up and targeted practices
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/70e67977f3da465d9bf9b4ca9345d28b
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Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices

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