Emergency Nurses' Use of Nurse-Initiated Protocols for Pain at Triage: One Hospital's Experience

2.50
Hdl Handle:
http://hdl.handle.net/10755/162678
Type:
Presentation
Title:
Emergency Nurses' Use of Nurse-Initiated Protocols for Pain at Triage: One Hospital's Experience
Abstract:
Emergency Nurses' Use of Nurse-Initiated Protocols for Pain at Triage: One Hospital's Experience
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Taylor, Janice C., RN, BSN, CEN
P.I. Institution Name:St. Joseph Hospital
Title:RN Staff Nurse
Contact Address:2901 Squalicum Pkwy, Bellingham , WA, 98248, USA
Contact Telephone:(360) 738-6765
Co-Authors:Diana Meyer, RN, MSN, CCRN, CEN
[Clinical Poster] Clinical Topic: Patients with extremity injuries who had prolonged wait times were often observed not to have received any analgesics at triage, even though protocols were in place to allow this practice. This study explored the use of nurse-initiated protocols (NIP) for pain management in emergency departments (ED). The intent was to discern nurses? attitudes regarding NIP and how overcrowding and other factors influenced their use. It was thought that this information could lead to more consistent use of the protocols.

Implementation: An experienced triage nurse designed this study to explore how triage nurses' implemented NIP. 20 of the 38 triage nurses on staff participated. Nurses described their management of three case studies (pediatric, adult, and geriatric) with increasing workloads, in addition to candid 20-minute interviews regarding their attitudes and beliefs about what works and does not work with the present NIP. Participants were asked about factors that influenced their protocol implementation decisions, and how increased workload, length of wait, and patient pain levels affected their decisions. Responses were evaluated based on participants? gender, ethnicity, shift worked, years of experience as a registered nurse, certification status, and familiarity and use of the protocols. Data was collected in May 2006, with results evaluated in August and September, 2006.

Outcomes: All participants viewed NIP to be of great benefit to the patient, and expressed professional satisfaction in having the autonomy to implement the protocols, though they differed in their beliefs about when the NIP should be used. Participants were more apt to administer analgesics when patients had 2-hour waits to reach treatment areas versus those with no wait (93% versus 63%) and had directly observable injuries (95% versus 75%). Certified nurses and experienced nurses, though distinct groups, withheld medications slightly more often when there was no wait, (54% versus 52%) and 100% of both groups used NIP when waits were prolonged. Participants who reported being very familiar with NIP were 30% more likely to administer medications at triage when there were no waits to be seen. Female nurses were one-and-a-half times more likely than male nurses to use narcotics to treat pain (67% versus 44%), though the small number of men in the sample may have skewed the results. Qualitative analysis indicated that all nurses utilized clinical judgment skills to make their decision, based on both the needs of the patient and department situations. Heavy workload was cited by each participant as the primary reason for not implementing the protocol, as well as prolonged waits the most common reason to give analgesics. Many participants reflected that the extra time it took to administer medications deterred their use when it was most busy because it interfered with the primary function of triage. Process impediments, such as triple charting and lack of supplies, also hampered NIP use.

Recommendations: NIP for pain management at triage should include procedures for prolonged waits and patient re-evaluation. Procedures should be streamlined for efficiency. Continued training in pain management and NIP may increase their utilization. Administrative support is crucial to maintain the supplies and personnel at triage to expedite the care of each patient, including provision for multiple triage nurses to work simultaneously. Further research is needed to investigate possible differences in analgesic administration based on nurses' gender.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEmergency Nurses' Use of Nurse-Initiated Protocols for Pain at Triage: One Hospital's Experienceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162678-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Nurses' Use of Nurse-Initiated Protocols for Pain at Triage: One Hospital's Experience</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Taylor, Janice C., RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">St. Joseph Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">RN Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2901 Squalicum Pkwy, Bellingham , WA, 98248, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(360) 738-6765</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">taylorjw78@comcast.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Diana Meyer, RN, MSN, CCRN, CEN</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Patients with extremity injuries who had prolonged wait times were often observed not to have received any analgesics at triage, even though protocols were in place to allow this practice. This study explored the use of nurse-initiated protocols (NIP) for pain management in emergency departments (ED). The intent was to discern nurses? attitudes regarding NIP and how overcrowding and other factors influenced their use. It was thought that this information could lead to more consistent use of the protocols.<br/><br/>Implementation: An experienced triage nurse designed this study to explore how triage nurses' implemented NIP. 20 of the 38 triage nurses on staff participated. Nurses described their management of three case studies (pediatric, adult, and geriatric) with increasing workloads, in addition to candid 20-minute interviews regarding their attitudes and beliefs about what works and does not work with the present NIP. Participants were asked about factors that influenced their protocol implementation decisions, and how increased workload, length of wait, and patient pain levels affected their decisions. Responses were evaluated based on participants? gender, ethnicity, shift worked, years of experience as a registered nurse, certification status, and familiarity and use of the protocols. Data was collected in May 2006, with results evaluated in August and September, 2006.<br/><br/>Outcomes: All participants viewed NIP to be of great benefit to the patient, and expressed professional satisfaction in having the autonomy to implement the protocols, though they differed in their beliefs about when the NIP should be used. Participants were more apt to administer analgesics when patients had 2-hour waits to reach treatment areas versus those with no wait (93% versus 63%) and had directly observable injuries (95% versus 75%). Certified nurses and experienced nurses, though distinct groups, withheld medications slightly more often when there was no wait, (54% versus 52%) and 100% of both groups used NIP when waits were prolonged. Participants who reported being very familiar with NIP were 30% more likely to administer medications at triage when there were no waits to be seen. Female nurses were one-and-a-half times more likely than male nurses to use narcotics to treat pain (67% versus 44%), though the small number of men in the sample may have skewed the results. Qualitative analysis indicated that all nurses utilized clinical judgment skills to make their decision, based on both the needs of the patient and department situations. Heavy workload was cited by each participant as the primary reason for not implementing the protocol, as well as prolonged waits the most common reason to give analgesics. Many participants reflected that the extra time it took to administer medications deterred their use when it was most busy because it interfered with the primary function of triage. Process impediments, such as triple charting and lack of supplies, also hampered NIP use.<br/><br/>Recommendations: NIP for pain management at triage should include procedures for prolonged waits and patient re-evaluation. Procedures should be streamlined for efficiency. Continued training in pain management and NIP may increase their utilization. Administrative support is crucial to maintain the supplies and personnel at triage to expedite the care of each patient, including provision for multiple triage nurses to work simultaneously. Further research is needed to investigate possible differences in analgesic administration based on nurses' gender.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:17Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:17Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.