Purpose: To demonstrate that ward-based dressing changes offer an alternative to theatre-based procedures for burns patients, reducing the need for theatre resources and general anaesthesia. The absence of fasting requirements before the procedure allows flexibility in scheduling and preserves patients' nutritional status. In the Severe Burns Injury Service at Royal North Shore Hospital, a protocol utilising ward-based ketamine/midazolam patient-controlled analgesia (PCA) has been implemented for burns dressing changes, led by Nursing staff and overseen by a Pain Specialist and a Burns Surgeon. This study aims to evaluate the efficacy of this approach. Methodology: A prospective analysis between July and December 2023 of ward based dressing changes for burns patients required ketamine/midazolam PCA. Results: There were 34 procedures in 15 patients (12 males, 3 females) with an average age of 38. All patients had initially suffered flame burns covering an average total body surface area of 24.8%. In 28 procedures (82%), patients received oral opioid analgesia pre-procedure. Each procedure lasted an average of 98 minutes requiring two nurses for dressing change and one allied health member instigating range of motion and scar therapy. Despite a 30% incidence of transient hallucinations, patients reported high overall satisfaction. Adverse effects were minor and did not require any intervention. Conclusion: Ketamine/midazolam PCA regime is a safe and effective method to facilitate large burns dressing changes in a ward setting that would have alternatively required general anaesthesia and theatre resources. Further research encompassing a longer time frame is warranted to elucidate specific burns patient groups that may benefit from this pathway.