Results of a protocol for a nurse led analgesia intervention in an urban Emergency Department – Pain-Protocol Initiating Nurses (P-PIN) – a retrospective review

Mrs Natasha Jennings1, Ms Claire Hatherley1, Ms Rachel Cross1,2, Dr Grainne Lowe1,3, Dr Gerard O’Reilly1,4, Dr Biswadev Mitra1,4, Dr Paul Jennings5

1Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne VIC 3004; 2La Trobe University, Alfred Clinical School  Melbourne VIC 3004; 3Deakin University, Burwood, VIC 3125; 4National Trauma Reserach Institute, The Alfred Hospital, Prahran, VIC 3181; 5Department of Community Emergency Health and Paramedic Practice, Monash University

Background. Nurse led analgesia programs have been found to be safe and effective in reducing time to analgesia and improve 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 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. 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. There were 48 patients that received nurse led analgesia during the first 3 months of the protocol intervention. Compliance with the national target of patients receiving analgesia within 30 minutes was 91%. The median time to first dose of analgesia was 16 (IQR 10.5-26) mins. There were no adverse errors reported and documentation of PS was 100%. There was one protocol violation for nurse led analgesia being given to a patient with chest pain, which is an exclusion criterion.

Discussion. Pain protocols have been shown to improve the incidence, accuracy and documentation of pain assessment and treatment efficiency. Translation of these findings into clinical nursing practice helps to reduce the gap in translational of research to clinical practice.  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 is an emergency nurse practitioner with a focus on advancing nursing practice.

Claire is a Clinical Nurse Educator at the Alfred Emergency & Trauma Centre. She has completed her Masters of Nursing (Emergency Care) with a specific focus on emergency management and treatment of pain.