nurse initiated ED treatment

see also:

• EM nursing
• ED nurse initiated Mx - basic assessments
• ED nurse initiated analgesia
• ED nurse initiated Mx of isolated limb injuries
• ED nurse initiated Rx of the adult patient presenting with chest pain
• ED nurse initiated Rx of the patient with abdominal pain
• ED nurse initiated Rx of the patient presenting with asthma
• ED nurse initiated Rx of the patient presenting with headache
• ED nurse initiated Rx of the patient presenting with PV bleeding in early pregnancy
• ED nurse initiated Rx of the patient presenting with hyperemesis
• ED nurse initiated Rx of the patient presenting with probable UTI
• ED nurse initiated Rx of the adult patient presenting with back pain
• ED nurse initiated Rx of the patient presenting with probable renal colic
• ED nurse initiated Rx of the patient presenting with probable biliary colic
• ED nurse initiated Rx of the unwell elderly patient

• Western Health policies (intranet only):
  • Nurse initiated procedures (docx) - policy no longer on intranet!
  • Nurse Initiated X-rays (docx)
  • Nurse initiated medications (docx) - ED specific policy no longer on intranet!

• most emergency departments have major issues with ED overcrowding which results in longer waiting times for patients, delay to diagnostics and subsequent prolonged ED legth of stay, patient dissatisfaction, unmanaged clinical risk in the waiting room with delayed diagnosed of potentially time critical conditions, and increased levels of patients leaving without being seen.
• prolonged waiting times also potentially cause other issues:
  • infection risk from other nearby patients
  • exacerbation of ankle oedema from dependent sitting position
  • exacerbation of dehydration in the elderly in particular who are often already dehydrated
  • discomfort and potentially pressure sores in the elderly due to prolonged waits on uncomfortable seating
  • violence in the waiting room
• one method of addressing the above is to empower triage nurses to commence patients on a treatment pathway appropriate for their presenting complaint.

• abdominal pain ~10%
• isolated limb injury excluding laceration alone ~9%
• asthma, cough or SOB ~7%
• fever ~4%
• chest pain ~4%
• vomiting ~3.5%
• dizzy or lightheaded or collapse/fall ~3%
• laceration ~3%
• depression / psychosis ~2.5%
• possible miscarriage ~2%
• headache ~2%
• head injury ~1.8%
• skin infection / cellulitis ~ 1.5%
• backpain ~1.5%
• urinary complaint ?UTI ~1.4%
• overdose ~1%
• flank pain ?renal colic ?pyelonephritis ~0.8%
• croup 0.8%

• these nurse initiated treatment pathways may include:
  • analgesia
  • specific medications such as aspirin for chest pain, salbutamol inhaler for asthma, ondansetron wafers for vomiting
  • iv access and iv fluids
  • urinalysis including urine pregnancy testing for those who may be pregnant and not known to be pregnant who would otherwise be at risk of radiation from Xray referrals, or use of medications such as non-steroidal anti-inflammatory drugs (NSAIDs)
  • pathology testing related to the presenting complaint
  • radiology referral
  • escalation of medical referral
  • frequent reassessment