Emergency Department acute pain management and the impact of the nurse-initiated analgesia program

Abstract

Aim: Most Emergency Department (ED) patients have pain as a component of their presentation and require timely, effective and safe analgesia. Nurse initiated analgesia (NIA) procedures have been embedded into our ED practice for over two decades, and during this time no significant adverse events have been reported related to NIA. This study aimed to evaluate the predictors of timely effective pain management and the impact of NIA procedures.

Methods: This retrospective observational study included all patients who presented to the ED between 2017-2021 with a triage pain score of 4 or greater. Data were extracted from the Cerner electronic medical record. The primary endpoint was the proportion of patients who received timely analgesia (within 30 minutes of ED presentation). Potential predictors were identified from the literature and clinical experience, including whether the first dose of analgesia was initiated by a nurse or doctor.

Results: A total of 158,529 patients had a triage pain score of 4 or greater (9.1% less than 14 years, 15.2% > 70 years; 21.4% had a triage pain score of 8 or greater). Of the 109,860 patients administered analgesia in ED, 62,560 (56.9%) had their dose initiated by a nurse; 88% of these patients received timely analgesia. The most substantial predictor of timely analgesia was whether the first dose of analgesia was initiated by a nurse compared to a doctor (OR 5.8, 95%CI 5.7-6.0).

Conclusion: ED nurses can provide timely analgesia to a substantial proportion of ED patients. Various predictors of timely provision of analgesia in the ED have been explored. Timely provision of analgesia was more likely when analgesia was provided by a nurse.

Impact: When ED nurses can initiate pain-relief prior to patients being seen by a doctor, they are able to safely provide timely pain-relief to a substantial proportion of patients.