Study finds unacceptable delays in ED pain meds

If you would like to use standing orders for pain management in your ED, a new study's findings give you powerful evidence to share.

For patients 8 years or older who presented to the ED with moderate to severe pain, researchers compared four triage systems to see how quickly analgesics were given. They found that all of them, including the Emergency Severity Index (ESI), demonstrated unacceptably long times to administration of pain medications. Also, many patients received no analgesic at all during their ED stay.1

"We recommend exploration of nurse-initiated, standing analgesic orders to help improve the proportion of patients that get analgesics and the time to initial analgesics," says Paula Tanabe, PhD, RN, MPH, one of the study's authors and research assistant professor in the Department of Emergency Medicine at Northwestern University in Chicago.

There are no data on the number of EDs that use nurse-initiated standing analgesic orders, says Tanabe. "But the number is very small, and I would not say it is growing. In fact, it may be shrinking due to some places removing standing orders due to the medication safety concerns. If there are standing orders, most are for acetaminophen and ibuprofen."


  1. Ducharme J, Tanabe P, Homel P, et al. The influence of triage systems and triage scores on timeliness of ED analgesic administration. Am J Emerg Med 2008; 26:867-873.