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Learning Objective 1: The learner will be able to understand how nurse initated intranasal fentanyl improves time to analgesia for children presenting to the emergency department.
Learning Objective 2: The learner will be able to gain insight into clinical nursing research implemented in the emergency department
Limb fractures are amongst the most common reasons for presentation of children to the emergency department(ED) in Australia. With injury comes pain; however many children do not receive timely analgesia despite national recommendations advocating analgesia within thirty minutes of triage. Timely analgesia is important in children as inappropriate or delayed management of pain can lead to emotional distress and contribute to heightened pain perception, causing anxiety, distress and anger during subsequent treatments. Painful experiences in hospital during childhood influence the child’s future health behaviours, manifesting in doctor phobias and avoidance of medical experiences and settings and contributing to poor health outcomes.
Project goals:
- To develop a nursing strategy to facilitate initiation of opioid analgesia at triage for children with suspected limb fracture and moderate to severe pain.
- To improve time to analgesia in children presenting to the emergency department with suspected limb fracture.
Methods:
To facilitate nurse initiated intranasal fentanyl a policy was developed to guide nurse initiated intranasal fentanyl by triage nurses in the emergency department. Prior to implementation of this policy all triage competent nurses were required to complete a learning guide and competency. Retrospective chart audits of all patients presenting with limb fractures provided a base line for time to analgesia in the selected patient group prior to implementation of nurse initiated intranasal fentanyl. A post implementation audit was then conducted to determine the impact of nurse initiated intranasal fentanyl on time to analgesia for children presenting with limb fractures.
Results:
Nurse initiated intranasal fentanyl improves time to analgesia in children presenting to the emergency department with limb injury.
Conclusion:
Nurse initiated analgesia improves time to analgesia in children presenting to the ED and supports efficient patient flow. The findings of this project supports further research in developing strategies for nurse initiated analgesia.