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Staff perceptions of pain in people with a learning disability: an emergency department investigation (poster presentation)

Timothy Williamson, Warwick Medical School
Co-presenter(s): Professor Matthew Cooke


In the emergency department (ED) an assessment of a patient's biopsychosocial requirements are analysed almost immediately and pain relief administered as required. Pain relief is administered daily in the ED and can consist of non-pharmacological interventions and pharmacological interventions. Non-pharmacological methods include reassurance of the patient and splintage of an injured limb; pharmacological interventions range from a commonly used over the counter medication to morphine. A 0-10 subjective patient assessed pain scale is in common usage to help in assessing pain, where 0 = no pain and 10 = worst pain ever. Depending upon the number provided, along with certain physiological parameters, the relevant level of analgesia will be administered. Change in score is then used to asses effectiveness of pain relief and need for further analgesia. Full communication can be utilised in many people entering the ED. However, people with a learning disability could be disadvantaged. This is because only their physical signs and details ascertained from their carer can being utilised, with behavioural and non-verbal cues of pain potentially masked. This paper will discuss some of the preliminary findings regarding the views of staff in an ED on providing analgesia to people with a learning disability. Doctors and nurses will complete a set of scenario based questionnaires of people attending the ED with specific illnesses and injuries. Four scenarios will be utilised reflecting a range of clinical situations. These will detail relevant physiological parameters available in the ED and additional patient signs that are commonly seen. The main communicative common indicator for analgesic delivery, the pain score, will not be provided. Four patient descriptions (including a patient with learning difficulties) will be randomly assigned to the scenarios for each participant. This will be utilised to determine if there is a difference in how healthcare professionals approach the treatment of pain to people with a learning disability when compared to other individuals in identical clinical scenarios. In a person with a learning disability: Is non-pharmacological analgesia utilised more? Are smaller doses of pharmacological analgesia administered? Is there a difference in the healthcare specialities?

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