Last month’s coding of the new routes went well and regression testing (where we test that the new code does not disturb the pre-existing programing), only produced one very minor headache.

However headaches come in all degrees and this month, I started coding up the analgesia selection part of the OUCH™ pain scoring system.

We are not seeking to tell nurses what to do, but to give a range of different but appropriate analgesics, routes of administration, and doses, from which they can select and document, the patient’s best option. Since SortED is intended for use in both adults and children we also need to cope with paediatric options too.

It is essential that we have do not have a cluttered screen, nor too many click/tap events. With SortED in a triage setting, Sorts took a remarkable 1.43 minutes (interquartile range – IQR 1.13-2.07). I was pleased and impressed with that, since even though SortED is designed for rapid data capture and decision-making, our nurses had tested 20 steps in the Sort procedure.

With SortED v1.4 (adapted for use in the Urgent Care Centre), and testing 22 steps, Sorts during the streaming consultation took a median 2.1 minutes (IQR 1.2-3.3). My aim is that this new component should not delay the Sort process by more than a few seconds, but ensure rapid and appropriate analgesia. We know from the control series in our ED trial that analgesia is ordered at an unacceptably long interval after arrival (at a median 88 minutes – IQR 50-136) and in UCC is often not given until the second consultation (median 123 minutes – IQR 85.0-174.5). In contrast, our nurses identified the need for analgesia during the ~ 2 minute Sort, but were not prompted with suggestions of what to chose.

OUCH not only helps score and characterise the pain but also documents whether the patient has taken analgesia before arrival and, if so, when.

Both trials have shown that at streaming and triage patients often refuse analgesia when it is first offered so I’ve added that as an option too.

Gillie Francis – Oct 2018