ED nurse initiated Rx of the patient presenting with probable biliary colic

see also:

• EM nursing
• nurse initiated ED treatment
• ED nurse initiated analgesia
• Western Health policies (intranet only):
  • Nurse initiated procedures
  • Nurse Initiated X-rays
  • Nurse Initiated Intravenous Opioid Analgesia Standing Orders

• patients with biliary colic can be initially managed in Fast Track if clinically stable, and if ongoing pain, can be considered for admission to EOU
• their length of stay in ED could be reduced and their symptoms partly relieved by nurse initiated ED Rx, although it is recognised that these presentations can be complex and warrant timely medical assessment to properly exclude important red flags.
• the following is a suggested framework for ED's who have nurses accredited to undertake ED nurse initiated treatment including the ordering of pathology tests.

• see also: basic nursing assessment common to all pathways

• see also: biliary colic and cholecystitis

• hypotension
• fever
• severe pain
• pregnancy

• urinalysis with MSU m/c/s
• if persisting pain, consider admission to EOU as biliary colic:
  • iv access
  • FBE, U&E, glucose, LFTs, lipase
  • iv morphine if not settling with paraectamol, oxycodone