Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T12:43:45.882Z Has data issue: false hasContentIssue false

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*
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

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Type
EM Advances • Innovations en MU
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Blau, WS, Dalton, JA, Lindley, C. Organisation of hospital-based acute pain management programs. South Med J 1999;92:465–71.CrossRefGoogle ScholarPubMed
2.Wilson, JE, Pendleton, JM. Oligoanalgesia in the emergency department. Am J Emerg Med 1989;7:620–3.CrossRefGoogle ScholarPubMed
3.Selbst, SM, Clark, M. Analgesic use in the emergency department. Ann Emerg Med 1990;19:1010–3.CrossRefGoogle ScholarPubMed
4.Reich, M. Bodiwala, GG. Use of analgesia in severe pain in the accident and emergency department. Arch Emerg Med 1987;4:2531.Google Scholar
5.Lewis, LM, Lasater, LC, Brooks, CB. Are emergency physicians too stingy with analgesics? South Med J 1994;87:79.CrossRefGoogle ScholarPubMed
6.Ducharme, J, Barber, C. A prospective blinded study on emergency pain assessment and therapy. J Emerg Med 1995;13:571–5.CrossRefGoogle Scholar
7.Barletta, JF, Erstad, BL, Loew, M, Keim, SM. A prospective study of pain control in the emergency department. Am J Ther 2000;7:251–5.Google Scholar
8.Ducharme, J. Proceedings from the First International Symposium on Pain Research in Emergency Departments. Ann Emerg Med. 1996;27:399403.CrossRefGoogle Scholar
9.Liebelt, E, Levick, N. Acute pain management, analgesia and anxiolysis in the adult patient. In: Emergency medicine. A comprehensive study guide. 5th ed. New York: McGraw-Hill; 1999.Google Scholar
10.Kelly, AM. A process approach to improving pain management in the emergency department: development and evaluation. J Accid Emerg Med 2000;17:185–7.CrossRefGoogle ScholarPubMed
11.Kelly, AM. Nurse-managed analgesia for renal colic pain in the emergency department. Aust Health Rev 2000;23:185–9.CrossRefGoogle ScholarPubMed
12.Coman, M, Kelly, AM. Safety of a nurse-managed, titrated analgesia protocol for the management of severe pain in the emergency department. Emerg Med (Fremantle) 1999;11:128–31.Google Scholar
13.Australasian College for Emergency Medicine. Guidelines for Implementation of the Australasian Triage Scale in Emergency Medicine. Nov 2000. Available: http://www.acem.org.au/open/documents/triageguide.htm (revised National Triage Scale; formulated and adopted by the College 2000 Nov; accessed 2005 Apr 7).Google Scholar
14.Woolf, SH. Practice guidelines: a new reality in medicine. III. Impact on patient care. Arch Intern Med 1993;153(23):2646–55.Google Scholar
15.Larsen, D. An investigation into the assessment and management of pain by triage nurses in greater London A&E departments. Emerg Nurs 2000;8:1824.Google Scholar
16.Fry, M, Holdgate, A. Nurse-initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia. Emerg Med (Fremantle) 2002;14:249–54.Google Scholar
17.Zohar, Z, Eitan, A, Halperin, P, Stolero, J, Hadid, S, Shemer, J, et al.Pain relief in major trauma patients: an Israeli perspective. J Trauma 2001;51:767–72.CrossRefGoogle ScholarPubMed
18.Goodacre, SW, Roden, RK. A protocol to improve analgesia use in the accident and emergency department. J Accid Emerg Med 1996;13:177–9.Google Scholar
19.Thomas, SH, Silen, W, Cheema, F, Reisner, A, Aman, S, Goldstein, JN, et al.Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: a prospective, randomised trial. J Am Coll Surg 2003;196:1831.Google Scholar
20.LoVecchio, F, Oster, N, Sturmann, K, Nelson, LS, Flashner, S, Finger, R. The use of analgesics in patients with abdominal pain. J Emerg Med 1997;15:775–9.Google Scholar
21.Pace, S, Burke, TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 1996;3: 1086–92.Google Scholar
22.Jones, M, Gough, P. Nurse prescribing - Why has it taken so long? Nurs Stand 1997;11(20):3942.Google ScholarPubMed