The aim of our project was to develop a nurse initiated analgesia program and evaluate its impact on provision of acute pain management. An algorithm was developed with multi-disciplinary input from ED nurses, pharmacists, doctors and a physiotherapist, in addition to the Acute Pain Service and Department of Surgery. The algorithm includes recommendations for mild, moderate and severe pain management using oral, rectal and parenteral analgesics and supportive measures. Nurses attended a one-hour in-service conducted by an ED pharmacist and nurse educator and were provided with a learning package that outlined pain assessment and the appropriate use of the selected analgesics in the algorithm. Nurses with Advanced Cardiac Life Support certification were required to successfully complete a take-home examination prior to using the algorithm.

Since the program's commencement in February there has been a significant reduction in time to delivery of the first dose of analgesia to patients presenting to the ED with pain. Collection of data evaluating the safety and timeliness of analgesia provision is ongoing.

The characteristics and reasons of patients leaving the emergency department prior to a medical assessment Margaret Fry, Jenny Thompson, Adam Chan & Violaine Carpenter

New South Wales Health reported an increased number of patients who 'did not wait' (DNW) for treatment compared with previous years.

Objectives The objectives of this study were to: (1) identify the characteristics and reasons of patients leaving prior to medical assessment; (2) identify the patient illness or condition, urgency code and nature of the ED encounter; and (3) identify the outcome of the DNW patient population.

Method The ED patient admission rate was 33% (15,298) and the D N W population for 2001-2002 was 3667 (8.0%). A thirteen question telephone survey was conducted which focused on the presenting complaint, waiting times, staff communication and outcomes.

Results During the three month study 222 patients were eligible to be contacted by telephone of which 144 (64%) patients were contacted. The study DNW group had an average age of 29 years (median 26 years) and the age range was between 1-88 years. Seventy one patients left as a result of the time delay while 21 (15%) patients left because their condition resolved, 18 (13%) felt too ill to stay, 13 (9%) received reassurance from the triage nurse and decided to leave, and 7 (5%) had their condition treated by the triage nurse. One patient (0.7%) left because of safety concerns in the waiting room, 5 (4%) had other commitments, 2 (1%) left to go to other facilities, 3 (2%) left because of staff rudeness and 3 (2%) reports were missing this field. Ninety-eight (68%) patients sought alternative medical attention within 24 hours of leaving the ED.

Conclusion The endemic problem of overcrowding is placing demands on EDs to review and, when appropriate reform, service delivery. While the study was conducted in a tertiary referral centre this ED is characteristic of most others across Australia and further outcome analysis of this vulnerable group is required.

Does the ATS category impact on the type and frequency of observations in the ED? Joy Lyneham, Felicity Astin & Katie Khoo

The introduction of a systematic national method of categorising patients as they present to the emergency department (ED) was a significant improvement in the practice of emergency nursing. There is variability in the type and frequency of observations for each individual patient based on the clinical judgement of the primary nurse in the ED. This is appropriate but imbedded in this practice are the underlying clinical judgments that are influenced by level of practice, emergency nursing experience and level of education. However the nature of this relationship has not been investigated. There is a contextual component to these interventions, such as number of presenting patients, the acuity and types of patients, staffing levels and the availability to transfer to the wards.

12 Supplement to AENJ Volume 6 Number 2,College of Emergency Nursing Australasia Ltd.