LONG-BONE FRACTURE PAIN MANAGEMENT IN THE EMERGENCY DEPARTMENT Authors: Ptlene Minick , PhD, RN, Patricia C. Clark , PhD, RN, FAHA, FAAN, Jo Ann Dalton , EdD, RN, FAAN, Eva Horne , MN, APRN-C, FNP, Debbie Greene , PhD, RN, and Monica Brown , RNC, MSN, FNP-C, APRN-BC, Atlanta, GA, Macon, GA Earn Up to 9 CE Hours. See page 315. Introduction: The purposes of this study were to investigate the adequacy of pain management for patients with long-bone fractures seen in the emergency department and to determine whether racial disparities exist. Methods: The design was an exploratory, correlational design using patient data abstract ed from electronic medical records of 2 major urban medical centers located in the Southeastern United States. Data collected included demographics, time of initial pain assessment by the registered nurse, time of pain medication administration, severity of pain, fracture location by radiograph, type of pain medication, and route-dosage of pain medication administered. The primary outcome variable, which was the pain management index, was calculated and used as a measure of adequate pain management. Results: The majority of the sample (N = 218) was female (61%) and white (63%), with 28% black and about 10% of the sample consisting of other minorities. Seventy-nine (36%) of the 218 patients received no medication while in the emergency department despite a mean pain score of 6.9 (SD = 2.5) on a 0 to 10 scale representing moderate to severe pain. Patients who received pain medication (n = 126) waited for the medication 1.76 hours (±1.47). Among the patients who received an analgesic (n = 126), younger patients, black patients, and those with higher pain severity were more likely to receive inadequate pain management than were white patients. Discussion: According to the pain management index, the majority of the patients in this study received inadequate pain management while in the emergency department. Future interventions may need to focus on giving ED nurses information about inadequate pain management and disparities in pain management in the ED setting and exploring possible reasons for disparities in order to ultimately improve patient care. Key words: Pain management; Disparities; Analgesics; Opioid; Musculoskeletal diseases; Drug therapy; Pain measurement E very year almost 2 million people are admitted to the emergency department in the United States with long-bone fractures (LBFs). Most of these patients present with moderate to severe pain. Recom- mendations for the assessment and treatment of acute pain are well established. 1 Barring contraindications, patients should receive an opioid analgesic while in the emergency department for LBF pain. 1 Yet research shows that almost half of all patients with LBF do not receive medication for pain in the emergency department. Furthermore, in some settings, blacks and other minority patients are less likely than are whites to receive medica- tion for pain. 2,3 The purposes of this study were to inves- tigate the adequacy of pain management for patients with LBF seen in the emergency department and to determine whether racial disparities exist in the pain management of patients who have LBFs. Racial disparities in pain management have been docu- mented for cancer, 4,5 postsurgical, and LBF patients. 3 Todd and colleagues 2 found that acute pain management Ptlene Minick is Associate Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA. Patricia C. Clark is Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA. Jo Ann Dalton is Emerita Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Eva Horne is Clinical Assistant Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA. Debbie Greene is Associate Professor of Nursing, Macon State College, Macon, GA. Monica Brown is Assistant Professor of Nursing, Macon State College, Macon, GA. For correspondence, write: Ptlene Minick, PhD, RN, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA 30302; E-mail: pminick@gsu.edu. J Emerg Nurs 2012;38:211-7. Available online 23 March 2011. 0099-1767/$36.00 Copyright © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. doi: 10.1016/j.jen.2010.11.001 RESEARCH May 2012 VOLUME 38 • ISSUE 3 WWW.JENONLINE.ORG 211