Evaluating a medical directive for nurse-initiated analgesia in the Emergency Department.

Objectives: Although acute pain is a common presentation in the Emergency Department (ED), analgesics are often delayed until the patient is seen by a physician. We assessed the effect of a medical directive for nurse-initiated analgesia on time to first dose of analgesics, proportion of patients receiving analgesics in less than 30min, and total length of stay in the ED.

Methods: A medical directive for nurse-initiated analgesia was introduced in our ED in October 2011. This before-after health record review included all patients presenting to the ED with musculoskeletal back pain in 4month periods before and after implementation of the medical directive.

Results: A total of 524 cases were reviewed, of which 401 were included - 201 and 200 in the before and after implementation groups respectively. After implementation there was a shorter time to first dose of analgesic (mean of 118 vs 160min, p<0.001), and a higher proportion of patients receiving analgesics in the first 30min (20% vs 4%, p<0.001). However there was no difference in total proportion of patients receiving analgesics (71% vs 67%, p=0.46) or total length of stay in the ED (337 vs 323min, p=0.51).

Conclusions: A medical directive for nurse-initiated analgesia in the ED was associated with significantly reduced time to the first dose of analgesic, and increased the proportion of patients receiving analgesics within 30min. We can conclude that medical directives for nurse-initiated analgesia effectively improve the timeliness and quality of care for patients with acute pain.