Safety of a nurse‐managed, titrated analgesia protocol for the management of severe pain in the emergency department

Abstract

Objectives: The objectives of this study were: (i) to determine the adverse‐effects profile of a nurse‐managed, titrated intravenous analgesia protocol; and (ii) to characterize the use of opioid analgesics for acute pain in a setting where an intravenous analgesia protocol was in place. Method: Retrospective chart audit of 401 consecutive cases (May–July 1996) of opioid analgesic administration for the management of pain in an adult metropolitan emergency department was performed. Results: Of the 401 cases, 345 (86%) received opioid analgesia using the nurse‐managed, titrated analgesia protocol. Nineteen adverse events were documented in this group (5.5% of patients; 95% CI = 3.3–8.5%). There were 17 episodes of hypotension (blood pressure below 100 mmHg), one hypersensitivity reaction and one vagal reaction. There were no documented cases of respiratory depression and no patient was administered naloxone. Of the patients suffering hypotension, seven required no intervention and the remaining 10 responded well to an infusion of fluids. Conclusion: The nurse‐managed, titrated intravenous analgesia protocol is a well‐used and safe method of providing analgesia.