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Nurse-initiated administration of paracetamol and ibuprofen at triage enables faster, safe, and effective management of pediatric pain and fever, improving patient comfort and streamlining emergency department workflow.
A newly proposed clinical framework strengthens the role of triage nurse in tackling pediatric pain and fever in the emergency department (ED). The consensus-based flowcharts allow timely, nurse-initiated administration of paracetamol and ibuprofen, helping minimize treatment delays while maintaining patient safety.
Prompt treatment of acute pain and fever in children is fundamental to minimize distress and improve overall ED experience. Delays in symptom control remain common, especially during peak hours. The proposed model enables structured, nurse-led intervention at triage, ensuring faster relief under defined safety criteria.
The recommendations were developed through three regional expert meetings. A restricted working group of three chairmen drafted the initial protocol after reviewing existing regional ED practices. The proposal was then discussed and refined with a wider panel that included Directors of Pediatric Emergency Departments, Directors of Pediatric Departments, and regional child healthcare management experts. A unified, consensus-based recommendation was finalized for broader ED implementation.
Two practical flowcharts were developed—one for pediatric pain and one for pediatric fever.
(a) For pediatric pain
The process begins with standardized pain assessment followed by a caregiver interview and screening for contraindications. Nurse-initiated analgesic administration (paracetamol or ibuprofen) is permitted when pain is rated 4–6 (moderate intensity) and no contraindications are present. Reassessment is mandatory after 1 hour, with pediatrician evaluation requested if clinically indicated.
(b) For pediatric fever
The protocol requires objective temperature measurement and determination of associated discomfort. An antipyretic is given only when the child’s temperature is ≥ 37.5 °C and at least one sign of discomfort is present. As with pain management, reassessment occurs after 1 hour, and escalation to pediatric review is arranged when necessary.
Thus, the proposed triage flowcharts integrate risk stratification, severity-based assessment, contraindication screening, and structured reassessment. By formalizing nurse-initiated administration of paracetamol and ibuprofen, the framework supports earlier symptom relief, improved workflow efficiency, and safer, standardized pediatric emergency care.
Children
Assessment and Management of Pain and Fever in Pediatric Patients in the Emergency Setting: A Proposed Flowchart for the Triage Nurse
Franca Benini et al.
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