Dr Natasha Jennings1, Ms Claire Hatherley1, Ms Rachel Cross1, Dr Grainne Lowe1, Dr Gerard O’Reilly1, Dr Dev Mitra1, Dr Paul Jennings2
1The Alfred, Prahran, Australia, 2Ambulance Victoria, Geelong, Australia
BACKGROUND. Nurse led analgesia programs are safe and effective in reducing time to analgesia and improving the quality of pain assessment and treatment. A pre-implementation study demonstrated poor compliance with the national target of patients receiving analgesia within 30 minutes (26.6%: 95% CI: 19.1-35.1), prolonged times for first doses of analgesia (median time 60.5 (IQR 30-87) mins and poor documentation of pain scores (PS; 52.3%). Pain protocol initiating nurses (P-PIN) in the emergency department (ED) of a busy urban hospital was introduced in December 2016 to standardise the approach to nurse led analgesia, reduce time to analgesia, improve pain score documentation and improve efficiency of pain control. The aim of this study was to evaluate the safety and effectiveness of this protocol.
METHODS. A retrospective explicit review of the medical records of all patients receiving P-PIN analgesia was conducted at one-month intervals for 12 months post intervention. Data extracted included patient demographics, compliance with the national standard of analgesia within 30minutes, time to first dose of analgesia, pain score documentation and protocol violations.
RESULTS. Preliminary data at 3, 6 and 9 months demonstrated significant reduction of time to analgesia and improved documentation of pain scores. The final results will be available for presentation at Research week.
DISCUSSION. Pain protocols improve the frequency, accuracy and documentation of pain assessment and treatment efficiency. Translational research is key to implementation of these findings into direct clinical nursing practice, reducing the gap between research and patient outcomes. A thorough implementation strategy and education program with close evaluation focusing on patient safety has been used to optimise outcomes for patients presenting with pain to the ED.
Tash and Claire are emergency nurses that have implemented and championed nurse initiated protocols at the Alfred Emergency and Trauma Centre.