1. DAASHH Time to Analgesia for Renal Colic

3. Aim 80% of patients presenting renal colic and documented pain, will receive analgesia within 30mins of arrival. Audit 20 notes monthly. Sylvia Boyes collecting additional data, including effective analgesia and actual Dr ‘seen by’ time.

4. Background 2012 Wanted to ensure time critical treatments provided within the 6 hour target in EC. Chose ‘Time to analgesia’ for patients with renal colic, as usually severe pain. Following patient journeys we learnt pain relief can be given within 10mins. Practical and realistic target of 30 mins chosen for audit.

5. A3 Methodology

6. Initiatives

7. How we going?

8. Barriers to Meeting Analgesia Goal Time to initial nursing assessment = 27min Area predominately staffed with new graduates and new staff. Time taken to complete initial assessment. Misunderstanding when to use red folder. Use of pain priority sticker. Pain score used only 24% of time. Missing documentation if patient still in pain

9. Example 1 22:18 – F/42 arrive at triage (TC3 – assessment). Pain priority sticker. (Indicates use of red folder). Abdo pain radiating to flank. Seen at A&M clinic, feels pain worsening. Pain score = 9/10. 22:40 – Initial nursing assessment. L) abdo pain radiating to flank. Ate mussels in morning. Given Mylanta, Panadol and codiene at A&M. Appears distressed = 9/10. Impression – renal colic / gastro? 23:05 – Phlebotomist places IV line. 23:25 – Pain relief. (Nurse initiated Morphine protocol). Analgesia = 1:07mins

10. Example 2 19:55 – M/27 arrive at triage. (TC2 – assessment). Pain priority sticker. (Indicates Red Folder use). L) flank pain - severe. Taken Panadol. Pain score = 10/10. 20:00 – Initial nursing assessment. Acute onset of severe L) flank pain with haematuria. Pain still = 10/10. Writhing in pain. Tender L) flank +++. 20:05 – Pain relief. (Nurse initiated Morphine protocol). 20:20 – Ongoing nursing assessment. IV, oral, PR analgesia. Patient looks slightly less distressed. Pain score = 10/10 to 7/10 Continue with pain relief as required. Analgesia = 10mins

11. Summary Challenging to improve time to analgesia Improved variation and time Increasing patient volumes currently biggest challenge Renal colic is just a “snap shot” of pain Still work to do