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Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions

Published online by Cambridge University Press:  21 May 2015

Anne-Maree Kelly ,
Catherine Brumby  and
Caroline Barnes
Anne-Maree Kelly*
Affiliation:
Joseph Epstein Centre for Emergency Medicine Research, Western Hospital, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria
Catherine Brumby
Affiliation:
Advanced Medical Science Program, The University of Melbourne, Melbourne
Caroline Barnes
Affiliation:
Department of Emergency Medicine, Western Hospital, Melbourne
*
Department of Emergency Medicine, Western Hospital, Private Bag, Footscray 3011, Melbourne, Victoria, Australia; +613 8345 6315, fax +613 9318 4790, [email protected]

Abstract

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Objectives:

Traditionally, patients have to wait until assessed by a physician for opioid analgesia to be administered, which contributes to delays to analgesia. Western Hospital developed a protocol enabling nurses to initiate opioid analgesia prior to medical assessment for selected conditions. The aim of this study was to determine the impact of this protocol on time to first opioid dose in patients presenting to the emergency department (ED) with renal or biliary colic.

Methods:

This was an explicit medical record review of all adult patients with an ED discharge diagnosis of renal or biliary colic presenting to a metropolitan teaching hospital ED. Patients were identified via the ED data management system. Data collected included demographics, condition, triage category, time of presentation, whether analgesia was nurse-initiated or not, and interval from arrival to first opioid analgesic dose. The narcotic drug register for the relevant period was also searched to cross-check whether opiates were doctor- or nurse-initiated.

Results:

There were 58 presentations in the nurse-initiated opioid analgesia group and 99 in the non-nurse-initiated analgesia group. Groups were reasonably well matched for gender, triage category and time of presentation, but there was a higher proportion of biliary colic in the non-nurse-initiated analgesia group. Median time to first analgesic dose was 31 minutes in the nurse-initiated group and 57 minutes in the non-nurse-initiated analgesia group (effect size, 26 minutes; 95% confidence interval 16-36 min; p < 0.0001]. There were no major adverse events in either group.

Conclusion:

A nurse-initiated opioid analgesia protocol reduces delays to opioid analgesia for patients with renal and biliary colic.

Keywords

emergency departmentanalgesianurse-initiated
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 3 , May 2005 , pp. 149 - 154
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

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