Go hard in the waiting room: Early methoxyflurane

Mrs Allison Jordan1, Mr Matt Luther1

1Calvary Public Hospital Bruce, Dunlop, Australia

Pain remains a primary impetus for people presenting to an Emergency Department (ED), yet literature suggests pain is frequently poorly managed in the ED setting.

Approximately 40% of Calvary Public Hospital Bruce’s ED presentations are related to minor trauma such as lacerations, falls, pushbike and sporting injuries. A clinician who recognises these injuries as non-life threatening may trivialise and subjectively assess the pain and administer suboptimal analgesia resulting in the patient experiencing pain while waiting to be seen. This can sometimes be for an extended period.

At the Calvary ED, the Advanced Practice and Triage Nurses utilise an ‘Initial Pain Management Procedure’ in which they may nurse initiate a single dose of medication(s) historically reserved for an acute area of an ED. These medications include methoxyflurane, fentanyl, morphine or oxycodone, as well as common and synergistic analgesia options such as paracetamol and ibuprofen.

Methoxyflurane is a volatile and self-administered inhalation analgesic indicated for short term use to aid in managing acute or procedural pain. Methoxyflurane is commonly utilised by Ambulance Services due to its ease of administration, fast action and effectiveness in relieving intense pain. These characteristics resemble the requirements for use in the ED as methoxyflurane provides an excellent non-invasive and patient controlled option to meet rapid pain relief requirements and expectations prior to synergistic analgesic agents.

Within the ED waiting room, the option of nurse administered methoxyflurane to a patient in the ED waiting area enables a rapid intervention and response to a patient reporting mild to severe pain, and has minimal impact on the subsequent treatment options available to manage more complex or longer term pain.

Methoxyflurane is accessible via a locked cupboard located at the triage desk. A Standard Operating Procedure for administering it has been developed and approved by the appropriate clinical and patient safety committees.

I am pleased to share the story of our introduction of methoxyflurane as an additional analgesic option for minor trauma within Emergency Department waiting room, and happy to report the anecdotal benefits of reduced patient discomfort and ensuing improved patient amenity.


Allison graduated in 2001 and commenced a New Graduate Program at Calvary Hospital. Once completing her new graduate year Allison moved to Victoria and worked at Werribee Hospital. The moving to Sydney to work at St George Hospital. This is where Allison found her love in life Emergency Nursing. In 2010 Allison successfully completed Masters of Nursing (Nurse Practitioner) and successfully applied for a Nurse Practitioner position at Calvary Public Hospital. Allison leads a team of 6 strong APN’s and leads the APN education program and teaches the APN training sessions. Allison has mentored many APN’s and Senior ED Nurses. Allison has a passion for adequate pain relief in the waiting room and for optimising paediatric pain relief in the ED.