Nurse initiated care of chest pain, the rural experience

SummaryIntroductionTimely management of patients who present to rural emergency departments without on-site medical officers is problematic. One approach to overcoming this problem is to develop nurse-initiated guidelines with standing orders that allow appropriately trained and accredited nurses to initiate care before the arrival of the medical officer. This paper examines the application of this process at a small rural emergency department.MethodologyA retrospective clinical audit was undertaken from June 2002 to June 2004 to evaluate the impact of the introduction of nurse initiated guidelines. The audit looked at short term patient outcomes for all presentations that were considered to have chest pain that was ischaemic in nature. There were two groups of patients: one group which received initial care from a nurse who was accredited to provide care utilising approved nurse-initiated guidelines before the arrival of a medical officer; and another group which received initial care by a medical officers or non-accredited nurses.ResultsDuring the audit period, 115 patients presenting to the emergency department were treated for chest pain that was ischaemic in nature. Fifty-six of these received their initial care from accredited nurses using the nurse-initiated guidelines and 59 received their initial care by non accredited registered nurses and the on-call medical officer. The results showed that when nurse-initiated care was available, nitrates and morphine were used significantly more frequently and the time to administration of nitrates was significantly shorter. There were no adverse events.ConclusionsThis audit has demonstrated that nurse-initiated care is a safe and effective practice, allowing a rural emergency department with limited resources to continually meet best practice standards and national triage benchmarks.