An Opiate Infusion Protocol for the Emergency Department: A Quality Improvement Project
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In 2019, the Center for Disease Control and Prevention (CDC) reported there were 139 million Emergency Department (ED) visits in the United States, with abdominal pain accounting for five to ten percent of these visits (Kendall et al., 2020). With pain being a quality-of-care indicator, ED providers aim to decrease patients’ pain scores quickly while awaiting diagnostic results. However, the United States is currently experiencing an opioid epidemic that has resulted in increasing morbidity and mortality rates along with a rapidly growing financial burden. With no nationally recognized quality measures or best practices in place, ED providers are now faced with finding ways to manage their patients’ acute pain without worsening this epidemic. In 2001, a study was completed that determined a 15-minute morphine infusion achieved the drugs peak effect at roughly the same time as a two-minute morphine bolus, however sustained a peak effect for a longer duration of time (Marsch et al., 2001). While this study did not analyze pain levels in relation to the rate of morphine administration, it does offer opportunity for a quality improvement (QI) project. For this QI project, an algorithm for patients presenting to Covington Medical Center’s ED with complaints of abdominal pain was created. If opioids were deemed necessary according to the algorithm, ED providers were prompted to order a 15-minute morphine infusion rather than the two-minute bolus which is currently the standard practice. This project, which consisted of two phases that extended over an eight week period, aimed to determine if patients who receive a 15-minute morphine infusion have more adequate and sustained pain relief when compared to a two-minute morphine bolus.
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