An audit of analgesic use for hand injuries in a private emergency department in Johannesburg

Abstract

Objectives: To describe the current analgesic practices for hand injuries used at a private hospital emergency department in Johannesburg, Gauteng and to explore any differences in analgesic practice between different doctor groups with different backgrounds, working in the ED. Design: Retrospective descriptive review. Setting: Private hospital emergency department in Johannesburg. Patients: A study sample of 423 patients who presented to the emergency department with hand injuries during 2010. Methods: The emergency department register was used to identify patients who presented with hand injuries. The clinical notes and where appropriate, nursing notes of the identified patients were reviewed. Main Results: Hand injuries were found to represent 9.3% of patients presenting to the emergency department. The most commonly used form of analgesia for hand injuries was found to be nerve blocks, which constituted 30% of the analgesic use. Digital blocks were the most frequently used block accounting for 69% of all nerve blocks done. Parenteral analgesia was the second most common form of analgesia implemented with the intramuscular route being most favoured. Specialised techniques such as nerve blocks are possibly underutilised by doctors with less surgical and emergency department experience. Conclusions: Analgesic practices between different doctor groups are varied. Standardising pain management for hand injuries should lead to improved utilisation of techniques such as nerve blocks. Guidelines should be available and include nerve block techniques. Training should be provided to doctors who are unfamiliar with the use of additional modalities such as nerve blocks.