Pain management: the use of a protocol for nursing triage in the emergency department

SEGAL N, DURAND-STOCCO C, TRUCHOT J, OULED N, YOUNGQUIST S T, PLAISANCE P. Pain management: the use of a protocol for nursing triage in the emergency department. Med Emergency, MJEM 2015; 22:3-7.
Key words: analgesia, clinical assessment, effectiveness, emergency department, nursing, pain control

  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement
Correspondent author: Nicolas SEGAL, MD, PHD

Department of Emergency Medicine, Lariboisière University Hospital

2, rue Ambroise Paré, 75010, Paris, France

Segal N, MD, PhD1, Durand-Stocco C, MD1, Truchot J, MD, MPh1, Ouled N, MD1, Youngquist ST, MD, MS2, Plaisance P, MD, PhD1

1. University of Paris Diderot, Sorbonne Paris Cité, UMRS 942, AP-HP, Hôpital Lariboisière, Emergency department, F-75018 Paris, France

2. University of Utah, Emergency department, Salt Lake City Utah, USA

Category: Original article

Received: Dec. 10, 2014

Revised: Jan. 1, 2015

Accepted: Feb. 18, 2015

There is no conflict of interest to declare


Aim: Pain management is an important element in an emergency department (ED). Based on existing guidelines for pain management a protocol was devised our emergency department allowing for the administration of an analgesic (World health organization levels 1 and 2) by the nurse without a medical prescription. The main objective of this study was to assess nurse compliance with the ED pain protocol. The secondary objective was to determine its effectiveness in reducing pain.

Methods: Design: Prospectively collected observational project following establishment of the protocol. Patients: All patients older than 15 with a Visual analog core (VAS) result > 0 were eligible for the study. Exclusion criteria were evidence of alcohol or drug intoxication, or inability to speak.

Results: Data collection sheets were completed for 226 patients. The protocol was followed exactly in 13% of patients. Nurses assessed pain and administered only a single analgesic without giving ketoprofen in 10% of cases. They evaluated pain and gave an incorrect analgesic to another 66% of patient. They gave an analgesic without documenting a pain assessment in 2% of patients. For all patients, the VAS did not significantly change between the nurse and the doctor assessment despite interval nurse analgesic administration (4.27 ± 1.49 versus 4.6 ± 2.83 respectively; p=0.27).

Discussion: The nurses in our ED do not follow the pain protocol as they should. A good training is required for an effective pain management. The issuances of analgesic limited to level 1 analgesic are insufficient.

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