Nurse initiated sedation in the Emergency Department: Diazepam and Droperidol

Mr Benjamin Learmont1, Mr Benjamin Horan2

1Princess Alexandra Hospital, Brisbane, Australia, 2Princess Alexandra Hospital, Brisbane, Australia

Emergency Departments (EDs) are often sites of impactful occupational violence; impactful on processes, care delivery and staff and patient wellbeing. Evidence suggests that often acutely disturbed patients can be well-managed using pharmacological means [1], but medical interventions can be delayed by patient load and acuity. This presentation will outline the processes one metropolitan tertiary ED used to upskill experienced nurses such that they are able to intervene pharmacologically (as well as behaviourally) in instances of significantly unstable patient behaviour. The capacity of nurses to effectively (autonomously) designate and administer Diazepam and Droperidol in the ED is unusual and under current evaluation – but the lessons learned from gaining such approvals can inform practice change in other EDs. Steps include:

  1. Identified need – Increased aggression and acutely behavioural disturbed patients. Indication to provide an effective and timely approach to violence and aggression within the ED.
  2. Support of a Toxicology Consultant for standing orders including Diazepam and Droperidol
  3. Discussion at departmental medication safety meeting including multidisciplinary inputs from ED Pharmacy, CNC team, medical staff and ED Director.
  4. Development of a proposed standing order and procedure.
  5. Approval from the hospital Drugs and Therapeutic Committee.
  6. Identification of appropriate nursing staff
  7. Development of competency and safety training and education for dissemination to and engagement by authorised staff.
  8. Standing order reviewed yearly.
  9. Ongoing audit and careful research evaluation as part of the trial

These will be discussed and barriers and enablers highlighted, with a view to enhancing capacity and autonomy for senior ED nurses.

  1. Johnston, A.N.B. et al., Interventions for people presenting to emergency departments with a mental health problem: a scoping review. EMA Dec 2018 EMA-2018-475. In press 2019

Biography:

Emergency Nursing for 10 years and has a interest in managing and decreasing occupational violence within the hospital setting. Currently has been working as a ROVE (Response to Occupational Violence Emergency) nurse in the Princess Alexandra Hospital.