uctDodpsiluaticqrtadpatwA

KdiNtrm

d

Ur

D

t

niibpgousm

ome

6th International Conference for Emergency Nurses

Keywords: Emergency department; Gender; Patients;Triage

doi:10.1016/j.aenj.2007.09.039

Nurse initiated intravenous opioid administration: How acommunity ED helped change legislation in the state ofVictoria, 2006

Denise Green∗, Anne-Maree Kelly

Emergency Department, Sunshine Hospital, WesternHealth, St Albans, VIC, Australia

What we know: A high percentage of patients present-ing to the emergency department are experiencing pain.This ranges from mild to severe and can be very distress-ing. Evidence supports the implementation of a processfor early initiation of analgesia. Our previous work showsthat a process for nurse initiated intravenous opioids inselected conditions is safe and reduces door to needle timefor patients presenting with acute severe pain.

What we never imagined: What we had considered a‘standing order’ arrangement was interpreted by authori-ties as nurses prescribing opioids! A change in legislation inthe State of Victoria was required to allow registered nursesto initiate administration of Schedule 8 medications. For-tunately, the research/audit-based approach we had takenfacilitated this to some extent. Share the 5-year journeyfrom 2001 to 2006 that our emergency department teamexperienced in the pursuit of implementing this evidencebased practice. And hear how our work is leading the world—–despite the hurdles.

Then decide for yourselves: ‘Was the outcome worththe effort?’

doi:10.1016/j.aenj.2007.09.040

Do urban emergency departments have all the answers orare there lessons in the remote frontiers of Australia forfuture directions? A research in progress paper

Peter Griswold

Halls Creek Hospital, Halls Creek, WA, Australia

The management of severely injured patients usuallyprovides large urban emergency departments with some oftheir greatest challenges in terms of guaranteeing rapidityof response, appropriately allocating human and physi-cal resources, and dealing with the distress of significantothers. Concurrently, patient stabilisation takes place, dete-rioration is prevented, and detailed clinical assessmentis systematically undertaken. When more than one suchpatient present s at a time, even specialist trauma centresand major urban emergency departments may be tem-porarily overwhelmed in the quest to achieve as muchas possible in the ‘golden hour’ post-trauma to optimisepatient outcomes. In many small rural hospitals and iso-lated health services, these challenges are compounded

by factors such as limited staff expertise, limited physicalresources, substantial time delays, and distance from ter-tiary services. Transfer and retrieval of patients to majorcentres is almost a necessity however delays of 24 h are not

id

f

203

ncommon before definitive care can be commenced at aentre possibly thousands of kilometres away. In the mean-ime, patient management rests with available clinicians.rawing on the experiences gleaned during the managementf a nine casualty remote area high-speed road traffic acci-ent in which seven patients sustained severe injuries, thisaper discusses particular emergency nursing challenges inmall hospitals located in some of Australia’s geographicallysolated environments. Underpinning this discussion, pre-iminary findings from a longitudinal research program aretilised to more broadly examine emergency health servicesnd patient outcomes in remote health centres, whilst illus-rating some of the key issues in the management of severelynjured patients where emergency resources are severelyonstrained. Questions are consequently raised about theuality of access to services in Australia’s remote areas,emote area health policy, and some of the beliefs and prac-ices that have developed surrounding the nature, urgencynd intensity of interventions in major urban emergencyepartments compared with their remote area counter-arts. The paper concludes by suggesting that some of thenswers for future directions in emergency nursing and bet-er patient outcomes may lie in the practices adopted inhat might be best described as the remote frontiers ofustralian health services.

eywords: Aboriginal health; Clinical practice; Emergencyepartments; Emergency nursing; Epidemiology; Health pol-cy; Hospital practice; Isolated nursing; Mass casualty care;urse practitioner; Nursing roles; Patient outcomes; Prac-ice standards; Remote area nursing; Remote area nursingesearch; Retrieval practices; Rural health; Trauma manage-ent

oi:10.1016/j.aenj.2007.09.041

tilising evidence to establish a short stay unit in aegional emergency department

avid Gullick∗, Brett Walters

Emergency Department, Goulburn Valley Health, Sheppar-on, VIC, Australia

Background: Short stay units are well established inter-ationally and in metropolitan emergency departments as annnovative strategy to manage patients requiring short stayn hospital for periods of up to 48 h. Short stay units haveeen utilised as a strategy to reduce bed block, improveatient satisfaction and improve patient flow in the emer-ency department. Goulburn Valley Health recently had thepportunity to establish a short stay unit as part of anpgrade and expansion of the emergency department. Thehort stay unit is one of the first to be established outside aetropolitan centre in Victoria.Objectives: (1) To determine the most appropriate model

f care for a new short stay unit in the emergency depart-ent at GV Health based on available evidence. (2) To

valuate the model of care in terms of specific outcomes

ncluding length of stay, admission diagnosis and dischargeestination.

Methods: A literature review was conducted searchingor information to guide policy development and systems at