CITATION
PURPOSE
SAMPLE/SETTING METHODS
Kelly A.M.,
Brumby, C.,
Barnes, C. (2005).
Nurse-initiated,
titrated IV opioid
analgesia reduces
time to analgesia
for selected painful
conditions. Can J
Emerg Med,
7(3):149-54
Retrospective
study to find
the impact of
Nurse-initiated
protocol on
time to first
opioid dose.
n= 157 visits of 126
patients to the
emergency
department of the
Western hospital at
Melbourne, Australia.
with diagnosis of
renal or biliary colic.
Fry, R., Ryan, J.,
Alexander, N.
(2004). A
prospective study
of nurse initiated
panadeine forte:
Expanding pain
management.
Accident and
Emergency
Nursing, 12 (3),
136-140. doi:
10.1016/j.aaen.200
Medical records
of the patients
were reviewed
using a data
collection tool by
two researchers.
Demographics
and whether
analgesia was
Nurse initiated
(NI) or doctor
initiated were
identified from
August 1, 2002 January 31,
2003. Data
analysis was
done using Chi
square and
Descriptive
statistics
Prospective
N = 202. 96% of
Analogue scale
exploratory
patients n= 195 met
was used to
study to
criteria and received
measure pain.
evaluate the
the drug. n = 7 (3%)
Data tool
effectiveness of received Panadeine
developed for the
using a specific Forte without meeting study collected
drug just after
criteria. Conducted
adherence to the
triage by RN
in a referral hospital's protocol. Data
ED in Australia in
was analyzed
2003 for 12 weeks
using the SPSS
package.
RESULTS
DISCUSSION &
LIMITATIONS
37% of samples
Generalizability
received NI and
may not be possible
63% by non NI;
as study includes
Inter-rater
nursing staff with
reliability of NI or
training, Nurse
non NI was
patient ratios, legal
measured on 82%
and political issues
of records with
may be different in
Kappa analysis
hospital setting.
yielding 0.92.
The groups were not
Median time to first randomized;
dose was 37 min for treatment group
the NI analgesia
were identified post
group and 57 min
hoc by chart review.
for the second
Documentation
group (Mannerrors and omissions
Whitney U test).
possible
No respiratory
depression were
identified
202 patients
received the drug
with an average
time of 23 min;
median time was 6
min. Average pain
score prior to
receiving the drug
was 68 mm and
after the drug
administration was
38 mm on the
analogue visual
Study cannot be
conducted in ED's
with inexperienced
nurses.
Convenience sample
makes
generalizability
difficult. Outcome
unknown regarding
patients left without
physician
evaluation.
Study had a vast
4.02.006
Muntlin, A.,
Carlsson, M.,
Safwenberg, U.,
Gunningberg, L.
(2011) Outcomes of
a nurse-initiated
intravenous
analgesic protocol
for abdominal pain
in an emergency
department: A
quasi-experimental
study. International
Journal of Nursing
Studies, 48(1), 13 23. doi:
10.1016/j.ijnurstu.2
010.06.003
Quasiexperimental
study to
compare
between
standard care
given in the ED
as opposed to
using nurseinitiated opioid
analgesic
ABA phase Quasiexperimental study
with n = 50 for A1, n
= 100 for B and n =
50 A2 at a Swedish
university hospital
ED.
Nurses were
educated to
assess pain and
use of pain
protocol.
Questionnaire for
ED patients was
developed to find
out perceptions
of pain
management.
Medical records
reviewed to
collect data on
pain assessment,
time to analgesic,
transit time in the
ED, frequency of
analgesic
administration.
scale of 100 mm.
Wilcoxon signed
rank test with p <
0.001 showed
statistically
significant lower
pain scores after the
drug was given.
Pain management
improved along
with patients
perception of pain.
Intervention phase
showed a
significant
reduction in
receiving analgesic.
exclusion criteria.
Questionnaire not
filled out by all
patients resulting in
drop outs. Some
patients refused
analgesic during the
intervention phase
and did not
complete questions.
Generalizability still
should be only to
Emergency
departments with
same type setting
and patients.