Island Health Authority, Royal Jubilee Hospital, 1952 Bay St, Victoria V8R 1J8, Canada; Island Health Authority, Victoria General Hospital, 1 Hospital Way, Victoria V8Z 6R5, Canada.
Island Health Authority, Royal Jubilee Hospital, 1952 Bay St, Victoria V8R 1J8, Canada; Island Health Authority, Victoria General Hospital, 1 Hospital Way, Victoria V8Z 6R5, Canada.
Int Emerg Nurs. 2024 Aug;75:101488. doi: 10.1016/j.ienj.2024.101488. Epub 2024 Jul 12.
Australian literature supports nurse-initiated opioid analgesia protocols may be effective, but this practice is not yet widely adopted in Canada.
Previous quality audits of Emergency Departments (EDs) in Victoria (Canada) indicate long delays to administration of analgesia.
Two tertiary care hospitals in a Canadian city of approximately 400,000 people were chosen for a quality improvement initiative. A manual retrospective chart review was conducted on a total of 122 patients which was compared to data from 125 patients from a previous audit in 2019.
ED nursing staff both hospitals were provided education and daily reminders to document pain score at triage, and to flag an acute analgesia opioid order set on the charts of patients with moderate or severe pain (greater than 4 out of 10 in the Numerical Rating Scale (NRS) or by triage nurse's clinical judgment). At Victoria General Hospital (VGH), nurses had the option of finding an emergency physician (EP) to sign the acute analgesia opioid order set, or independently administer IV opioids from a presigned order set without consulting an EP. At Royal Jubilee Hospital (RJH), nursing staff could only administer IV opioids from the order set after an EP was consulted. Median time to opioid analgesia after the intervention was compared to 2019 data for each hospital.
Each hospital significantly reduced median time to administration of opioids: VGH achieved 45.6 % reduction (1 h 8 min improvement, p = 0.001) and RJH achieved a 62.5 % reduction (2 h 11 min improvement, p < 0.001). Secondary outcomes indicated patients may receive analgesia faster when the opioid protocol was nurse initiated (median 43 minutes) vs physician initiated (median 1 h 1 min) at VGH. Pain score documentation at triage improved from <10 % in 2019 to >50 % in 2020 at both sites. Approximately 95 % of EP and nursing staff thought nurse-initiated opioids are safe, effective, and should be supported by regulatory boards.
Implementing a new triage protocol to expedite initiation of an analgesic protocol was associated with significantly reduced time to analgesia for patients with moderate to severe pain. Time reductions may be greater with nurse-initiated analgesia before physician assessment.
澳大利亚的文献支持护士主导的阿片类药物镇痛方案可能是有效的，但这种做法在加拿大尚未广泛采用。
加拿大维多利亚省（加拿大）之前对急诊部（ED）的质量审核表明，阿片类药物的给药时间延迟较长。
在加拿大一个拥有约 40 万人口的城市中，选择了两家三级保健医院进行质量改进计划。对总共 122 名患者进行了手动回顾性图表审查，并将数据与 2019 年之前审核中的 125 名患者的数据进行了比较。
为两家医院的急诊护理人员提供了教育和日常提醒，以在分诊时记录疼痛评分，并在中度或重度疼痛（数字评分量表（NRS）大于 4 或由分诊护士的临床判断）患者的图表上标记急性镇痛阿片类药物医嘱集。在维多利亚综合医院（VGH），护士可以选择找急诊医师（EP）签署急性镇痛阿片类药物医嘱集，或者在不咨询 EP 的情况下，从预签医嘱集中独立给予 IV 阿片类药物。在皇家朱比利医院（RJH），只有在咨询 EP 后，护理人员才能从医嘱集中给予 IV 阿片类药物。比较干预后每个医院阿片类药物镇痛的中位数时间。
每家医院的阿片类药物给药中位数时间都显著缩短：VGH 实现了 45.6%的降幅（1 小时 8 分钟的改善，p=0.001），RJH 实现了 62.5%的降幅（2 小时 11 分钟的改善，p<0.001）。次要结果表明，当阿片类药物方案由护士启动时（中位数 43 分钟），与由医生启动时（中位数 1 小时 1 分钟）相比，患者可能更快地接受镇痛，VGH 是如此。在两个地点，分诊时的疼痛评分记录从 2019 年的<10%提高到 2020 年的>50%。约 95%的 EP 和护理人员认为，护士主导的阿片类药物是安全、有效的，应得到监管机构的支持。
实施新的分诊方案以加快镇痛方案的启动，与中度至重度疼痛患者的镇痛时间显著缩短有关。在医生评估之前，由护士启动镇痛可能会带来更大的时间减少。
