Disposition

Inpatient or outpatient management determination of certain conditions may be affected by pain intensity alone. However, acute pain significant enough to warrant inpatient management is often associated with an underlying condition that is the primary reason for the admission. Safety of discharging patients home on narcotics with conditions necessitating acute pain management is dependent on two main precautions: a disease process that could be masked by analgesic medications and the likelihood of serious complications with the use of these medications in an unmonitored environment. Knowledge of the underlying pathologic diagnosis and an awareness of the home environment, support system, and the ability of the patient to manage home medications safely all impact on the determination for admission. Awareness of the duration of action of analgesic medications and the time of offset with respect to discharge planning and disposition is essential. Where the cause of the pain is determined and under control, long-acting medications minimize the frequency of analgesic medication. However, where there is less diagnostic clarity, these agents could be problematic in delaying symptom recognition by the patient until after discharge home. Longer acting pain medications are likely to result in longer ED stays, to monitor the patient's baseline pain and also to ensure the safety of discharge.

Written discharge instructions detailing specific medication procedures will help patients to take their medications correctly and also enhance patients' awareness of side effects. This information should include names of medications, dosages and frequencies, and adverse effects.

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