A pain protocol can be very useful to formalize pain treatment in patients with any painful condition. It can speed up analgesic administration, might increase pain assessment, pain score documentation and administration of pain medication, as well as efficient pain treatment. A pain protocol can be targeted specifically for physicians, but also for nursing staff. EM Online divides a pain protocol in 3 different kinds:

1. nurse-initiated pain protocol

This means that nursing staff is able to administer certain (opioid) analgesics autonomously, without interference of a treating physician. Usually there are strict patient conditions and there is some kind of formal training of nursing staff involved.

2. nurse-driven pain protocol

This means that nursing staff is allowed to administer (opioid) analgesic drugs after initial approval and signing-off by the treating physician. Usually, the physician writes the order for initial dosage as well as the subsequent incremental and the maximum dosages. Together with a nurse-initiated protocol, these are nurse-managed. 

3. pain protocol in general

In this pain protocol, it is usually not explicitly mentioned who administers analgesics, but most frequently it is physician-driven, in stead of nurse-managed. 

This current review on EM Online answers the following clinical questions for each of the 3 kinds of an implemented pain protocol after reviewing all available literature:

- does it increase assessment of pain?

- does it increase speed of administration?

- does it increase analgesic administration in general?

- is it safe to use? Are there adverse events associated with the use of it?

- is pain treated effectively and are more efficient routes of administration used?

- are patients satisfied with its use?

- does it influence total Emergency Department length of stay?

By clicking the button below, you will find an oversight of all published studies on these specific topics. Find out more about the pros and cons of a pain protocol and learn all about the implementation of a successful pain protocol in your Emergency Department!