title: Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department.
abstract: OBJECTIVE
  To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation).
  
  
  METHODS
  We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint. The study sample was randomly selected from a list of all eligible patients. Data were extracted electronically from the ED records and by explicit extraction from the medical record. Logistic regression models were constructed to assess associations with the three binary study end points.
  
  
  RESULTS
  1289 patients were enrolled. Patients were less likely to receive any analgesia if they presented 08:00-15:59 hours (OR 0.67, 95% CI 0.46 to 0.98) or 16:00-24:00 hours (OR 0.55, 95% CI 0.37 to 0.80) were triage category 5 (OR 0.20, 95% CI 0.08 to 0.49) or required an interpreter (OR 0.34, 95% CI 0.14 to 0.86). Patients were less likely to receive NIA or early analgesia if they were aged 56 years or more (OR 0.70 and 0.63; OR 0.57 and 0.21, respectively) or if they had received ambulance analgesia (OR 0.59, 95% CI 0.36 to 0.95; OR 0.38, 95% CI 0.20 to 0.74, respectively).
  
  
  CONCLUSIONS
  Patients who present during the daytime, have a triage category of 5 or require an interpreter are less likely to receive analgesia. Older patients and those who received ambulance analgesia are less likely to receive NIA or early analgesia.
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.|Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors: David McD
authors: DM
authors: Taylor
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.
authors: Jessie
authors: J
authors: Chen
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.
authors: Munad
authors: M
authors: Khan
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.
authors: Marina
authors: M
authors: Lee
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.
authors: Mani
authors: M
authors: Rajee
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.
authors: Michael
authors: M
authors: Yeoh
authors: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.
authors: Joanna R
authors: JR
authors: Richardson
authors: Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia.
authors: Antony M
authors: AM
authors: Ugoni
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000698:Analgesia / Q000379:methods* / Q000451:nursing; D000700:Analgesics / Q000008:administration & dosage*; D003144:Communication Barriers; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000451:nursing; D010147:Pain Measurement; D012189:Retrospective Studies; D014218:Triage
chemical_list: D000700:Analgesics
keywords: analgesia/pain control; emergency department; pain management