Dewhirst Sebastian, Zhao Yuan, MacKenzie Taryn, Cwinn Adam, Vaillancourt Christian
Department of Emergency Medicine, University of Ottawa, Canada.
Faculty of Medicine, University of Ottawa, Canada.
Int Emerg Nurs. 2017 Nov;35:13-18. doi: 10.1016/j.ienj.2017.05.005. Epub 2017 Jun 21.
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.
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.
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).
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.
尽管急性疼痛是急诊科常见的症状，但镇痛药往往会延迟使用，直到医生看过患者。我们评估了一项关于护士启动镇痛的医疗指令对首次使用镇痛药的时间、30分钟内接受镇痛药治疗的患者比例以及在急诊科的总停留时间的影响。
2011年10月，我们急诊科引入了一项关于护士启动镇痛的医疗指令。这项前后健康记录回顾包括了在该医疗指令实施前后4个月内所有因肌肉骨骼背痛就诊于急诊科的患者。
共审查了524例病例，其中401例被纳入研究——实施前组和实施后组分别为201例和200例。实施后，首次使用镇痛药的时间更短（平均118分钟对160分钟，p<0.001），且在最初30分钟内接受镇痛药治疗的患者比例更高（20%对4%，p<0.001）。然而，接受镇痛药治疗的患者总比例（71%对67%，p=0.46）或在急诊科的总停留时间（337分钟对323分钟，p=0.51）没有差异。
急诊科关于护士启动镇痛的医疗指令与首次使用镇痛药的时间显著缩短以及30分钟内接受镇痛药治疗的患者比例增加相关。我们可以得出结论，关于护士启动镇痛的医疗指令有效地提高了急性疼痛患者护理的及时性和质量。
