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Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department

Tacy, Rebeca M. DNP, APRN, FNP-NPc; Donaworth, Sherry DNP, ACNP-BC, FNP-BC; Ballman, Kathleen DNP, APRN, ACNP-BC, CEN

Advanced Emergency Nursing Journal: April/June 2017 - Volume 39 - Issue 2 - p 123–140
doi: 10.1097/TME.0000000000000144

Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project. The Guideline for the Evidence-Informed Primary Care Management of Low Back Pain from the National Guideline Clearinghouse is introduced. Interprofessional collaboration for immediate referrals was implemented. The plan-do-study-act model was applied with descriptive analysis of the data. Reflective of established specific aims of the project, there was increased (1) support for the use of evidence-based practice guideline among the ED providers and staff, (2) use of evidence-based practices, (3) connection of patients to community resources, (4) evidence-based education for patients, and (5) overall satisfaction with pain management. The effectiveness of the application of this primary care guideline in the ED opens the way both for region-wide application of the guidelines and for the introduction of other primary care practice guidelines for patients who present to the ED with other chronic conditions.

Thomas More College, Crestview Hills, Kentucky, (Dr Tacy); and University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Donaworth and Ballman).

Corresponding Author: Rebeca M. Tacy, DNP, APRN, FNP-NPc, Thomas More College, 333 Thomas More Pkwy, Crestview Hills, KY 41017 (

The principal author acknowledges the leadership, mentoring, and collaboration of the faculty from the University of Cincinnati College of Nursing and colleagues from Thomas More College through the process and implementation. Specific appreciation and gratitude are given to all the frontline physicians, nurse practitioners, nurses, and staff of the emergency department for their support and valuable insights for the project and because of their willingness to adopt the project wholeheartedly to effect true changes for this patient population

Disclosure: The authors report no conflicts of interest.

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