562 Retrospective Study on Pain Management Pathway for Patients with Suspected Renal/ Ureteric Colic in a UK Accidents and Emergency DepartmentC Ojo, U Osunde, S Thapa, M L Lim, M Kelly
To understand local compliance with the NICE guideline for pain management in suspected renal/ ureteric stones which includes use of NSAIDS, Intravenous Paracetamol and Opioids as first, second and third-line analgesics respectively and not offering antispasmodics.
This was a retrospective single centre study wherein records of patients suspected to have renal/ ureteric colic between 18th July, 2022 and 30th September, 2022 were retrieved. Patients were identified by their presenting complaints of “loin-to-groin” pain at triage and “working diagnosis” from comprehensive history-taking and examination. We checked the first, second and third-line analgesics administered and, if Buscopan was given. Data was entered into Microsoft Excel and our pain management pathway matched against NICE guideline.
78 patients were suspected to have renal/ ureteric colic. M:F = 1.2:1. CT-KUB confirmed 90% to have stones and 3% to have no stones. 6% did not have CT-KUB done because they were young patients and urinalysis showed no microscopic hematuria. One patient self-discharged before CT-KUB was done. Overall, compliance with the NICE pain management guideline for suspected renal/ ureteric stones was full in 22% of cases but poor in 78% of cases.
Clinicians ability to correctly diagnose renal/ ureteric stones is remarkable. However, the low compliance rate is concerning. This may be due to poor awareness of the NICE guideline or doctors having affinity for certain analgesics as compared to others. This information will be used to explore further with the clinical team, reasons for non-compliance, develop a teaching strategy and perform a re-audit thereafter.