Table 2 Example team assumptions and “rules” for nurse-initiated analgesia in the ED

• NIA must only be initiated at triage on the child’s arrival to ED

• Analgesia (NIA or otherwise) could not be initiated at triage

• Analgesia could not be initiated at triage if there is a queue

• Analgesia could not be initiated if the ambulance service had given opioids prior to arrival

• Only nurses who had attended a specific workshop could nurse initiate opioids

• Only senior nurses could be approved to nurse initiate opioids

• Policy required 3 or 4 registered nurses to initiate, check and administer analgesia

• Enrolled nurses are not permitted to act as checkers for opioid medications

• Approval to nurse initiate opioids was an individual practice choice

• Analgesia could not be given or kept at triage

• Nurses could not initiate analgesia if unable to weigh children: estimating weight is not permitted for analgesia but is permitted for other purposes

• ED oral liquid opioid medication supply was limited to 20 ml bottles because of potential errors (measuring/administering)

• Casual pool RNs (who worked regularly in the ED) were not approved to nurse initiate analgesia

• NIA could not be initiated if the child had been allocated to a nurse practitioner or doctor