Implementing Evidence for Practice: Assignment 2

al., 2011). This is an unacceptable length of time to leave someone to suffer. A national standard

of time to first analgesia has been identified as 30 minutes (Doherty, Knott, Bennetts, Jazayeri,

& Huckson, 2013). There have been attempts to bridge the gap in providing timely and effective

pain management in the Emergency Department. Nurse Initiated Analgesia (NIA) is one modality

that has been recommended internationally. NIA is the provision of analgesics by a non-

prescribing nurse following a set protocol for administration by means of hospital approval or

standing orders (Cabilan & Boyde, 2017; Hatherley et al., 2016). ED nurses are in prime place to

pioneer such interventions as they are on the front-line of healthcare provision where patients

seek help (Fry et al., 2011). Concerns are often raised on the potential of adverse events

occurring from such interventions but research has shown there is low-risk of adverse events

occurring once a strict protocol is in place (Cabilan & Boyde, 2017). Further study is however

needed to substantiate this to aid alleviating fears of organisations and departments.

Clinical Question & Search Strategy

The setting for which this review is being performed is a tertiary paediatric trauma centre in

Melbourne that sees up to 90,000 patients per annum. Nursing staff can initiate some

medications as per protocol which include, first dose salbutamol, topical anaesthetics and

paracetamol. For anything stronger, including non-steroidal anti-inflammatories (NSAIDs), a

medical prescription is required. This often leads to reduced provision of sufficient analgesia or

a significant increase in time to analgesia. It is hypothesized that implementing a more extensive

nurse initiated analgesia protocol would significantly increase the provision of analgesia to

patients in moderate or severe pain as well as reduce the time to analgesia.

For the purposes of this paper, a PICO format will be utilised to develop the clinical question to

guide the literature review. The clinical question for this review is: