Emergency Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia.
Emergency Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia; Division of Emergency Medicine, University of Western Australia, Stirling Highway, Nedlands, Western Australia, Australia.
Int Emerg Nurs. 2024 Jun;74:101445. doi: 10.1016/j.ienj.2024.101445. Epub 2024 Apr 4.
Pain relief is a priority for patients with hip fractures who present to Emergency Departments (EDs). Intranasal fentanyl (INF) is an ideal option for nurse initiated analgesia as it does not require intravenous access and can expedite care prior to examination by a physician.
Pain relief in patients with hip fractures is delayed during episodes of ED crowding.
A retrospective medical record review was conducted following introduction of an INF guideline in an adult ED in 2018. Patients were included over a 4-month period during which the guideline was introduced. Historical and concurrent control groups receiving usual care were compared to patients receiving INF.
This quality improvement initiative investigated whether an INF analgesia at triage guideline would decrease time to analgesic administration in adults with hip fracture in ED.
This study included 112 patients diagnosed with fractured hips of which 16 patients received INF. Background characteristics were similar between groups. Mean time to analgesic administration (53 v 110 minutes), time to x-ray (46 v 75 minutes), and ED length of stay (234 v 298 minutes) were significantly decreased in the intervention group. Inadequate documentation was a limiting factor in determining improved efficacy of analgesia.
Use of triage-initiated INF significantly decreased time to analgesic administration, time to imaging and overall length of stay in ED.
急诊部（ED）就诊的髋部骨折患者首要关注的是缓解疼痛。鼻内芬太尼（INF）是一种理想的护士启动镇痛选择，因为它不需要静脉通路，可以在医生检查之前加快护理进程。
在 ED 拥挤期间，髋部骨折患者的疼痛缓解会延迟。
在 2018 年推出 INF 指南后，对成人 ED 进行了回顾性病历审查。在引入指南的 4 个月期间纳入了患者。历史组和同时期接受常规护理的对照组与接受 INF 的患者进行了比较。
这项质量改进计划研究了在 ED 中，对髋部骨折成人进行分诊时使用 INF 镇痛是否会缩短镇痛药物的给药时间。
本研究纳入了 112 例确诊为髋部骨折的患者，其中 16 例患者接受了 INF。两组患者的背景特征相似。干预组的平均镇痛药物给药时间（53 分钟比 110 分钟）、X 光检查时间（46 分钟比 75 分钟）和 ED 住院时间（234 分钟比 298 分钟）显著缩短。但在确定镇痛效果改善方面，记录不足是一个限制因素。
分诊时使用 INF 可显著缩短镇痛药物给药时间、影像学检查时间和 ED 住院时间。
