A protocol for a nurse led analgesia intervention in an urban emergency department

Jennings, N1, Hatherley, C1, Cross, R2, Lowe, G1, O’Reilly, G3, Mitra, B3, Jennings, P4

1 Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Prahran, Vic, 3181, n.jennings@alfred.org.au
2 La Trobe University and Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Prahran, Vic, 3181
3 Emergency and Trauma Centre, The Alfred Hospital, Head, International Programs National Trauma Research Institute, Commercial Road, Prahran, Vic, 3181
4 Department of Community Emergency Health and Paramedic Practice, Monash University

Aim: To describe a protocol of nurse led analgesia in the emergency department (ED) of a busy urban hospital. The aim of the protocol is to standardise the approach to nurse led analgesia, reduce time to analgesia, improve pain score documentation and improve efficiency of pain control. Pain-Protocol Initiating Nurses (P-PIN) will be able to administer analgesic medications using standing orders according to a pain protocol prior to the patient being assessed by the treating practitioner in the ED.

Background: Research exploring nurse led analgesia programs has found that they are safe, effective, help reduce time to analgesia and improve the quality of pain assessment and treatment. However, time taken from patient arrival to the ED to analgesia administration has often been observed to be long and around 90 minutes, far exceeding established practice recommendations of 30 minutes.

Discussion: Clinical guidelines have been shown to lead to improvements in both clinical and health outcomes. Specifically pain protocols have been shown to improve the incidence, accuracy and documentation of pain assessment.  A literature review was undertaken exploring best practice standards for acute pain in the emergency department. This body of work informed the development of the nurse initiated analgesia program.  The P-PIN program was developed in collaboration with key stakeholders with careful consideration of the inclusion and exclusion criteria and contraindications.  The medications chosen for the P-PIN program were based on best evidence and in alignment with the health services permit for standing orders for nurse led medications.


Tash is an emergency nurse working at the Alfred emergency and trauma centre. She is also a nurse practitioner. Tash has specifically an interest in analgesia and the development of nurse initiated protocols.