When children and teenagers come to the emergency room (ER) with a broken bone, it’s important that they are offered medications quickly to help reduce their pain. Therapies outside of medications are also used to help combat the patient’s pain. Splinting, distractions (reading and playing), and lowering the room lights to encourage sleep can help.  Patients, or their guardians, can refuse any medications.

What is this measure?

If a patient comes to the ER with a broken arm, leg or joint fracture (these types of breaks are known as “long bone” fractures), he or she should be offered pain medications within 60 minutes of their arrival. This medicine is the first step in treating the patient and is given to reduce the patient’s pain level. The Joint Commission, a health care accreditation organization, adopted this national measure to help reduce pain levels in pediatric patients.

Why is it important?

When patients suffer a bone fracture there is typically pain involved. Often, patients wait a long time in the ER for an X-ray to determine the appropriate treatment plan. It is important that patients are offered pain medications to help make them comfortable. Patients may decline the medications if they choose.

What is Johns Hopkins doing to improve?

Throughout Johns Hopkins Medicine, we are educating our doctors and nurses on the importance of offering pain relief quickly to patients who suffer long bone fractures. We are also developing plans that allow nurses to make the decision whether to offer pain relief, and to offer it as quickly as possible.

Finally, we provide monthly reports to our care teams on how well we do in meeting the 60-minute goal. Leadership and the care teams review any cases that don’t meet the goal.

Frontline Perspective

Pediatrics patient safety nurse Carolyn Neste attributes ongoing monitoring, open communication and team accountability to their success in improving this core measure.

Carolyn M. Neste, R.N., M.S.N.
Emergency Department/Pediatrics Patient Safety Nurse
Department of Emergency Medicine
Johns Hopkins Bayview Medical Center

“Patients who come to the emergency room with a long bone fracture, such as a broken bone in the arm or leg, are often in significant pain. Providing these patients with quick pain relief is important for both their comfort and experience.

“A couple of years ago, our hospital developed a report that tracked the timeliness of administering pain medications to patients who came to the emergency room with a long bone fracture. Whenever we did not meet our time goal for giving pain medicine to a patient, an email was sent to every doctor and nurse to make them aware of the failure. The email included an explanation of why meeting the time goal was important and clarified everyone’s role in being successful. Within a couple of months, our performance improved and we started meeting our goal.

“Every month, we continue to review our data and share it with our leadership team. When there are times that we aren’t meeting our target, we’ll discuss during our safety meetings possible reasons for the failures and solutions to the issues. This sharing of data promotes transparency and encourages the staff to meet our established goal as a team.

“This is all about improving the patient experience and patient safety. I am proud of the teamwork that has resulted in our staff members working to improve our performance in this area.”

How can patients and family support safety?

Patients and their guardians should communicate openly about their pain level. This includes what is working and what is not working in reducing the pain. Also, feel free to ask the doctors and nurses about other pain relief options. For example: splinting, distractions such as reading and games, and lowering the lights for a nap.

Quality and Safety Performance During COVID-19

The organization’s quality and safety performance may have been impacted by the COVID-19 pandemic. We would urge patients to consider more recent performance in combination with historical performance. Patients may benefit from discussing with their healthcare provider the disruptions COVID-19 may have caused on quality and safety of care.

See how Johns Hopkins Medicine prioritizes safety during the COVID-19 pandemic.