title: The implementation of intranasal fentanyl for children in a mixed adult and pediatric emergency department reduces time to analgesic administration.
abstract: OBJECTIVE
  The objective was to determine whether the introduction of intranasal (IN) fentanyl for children with acute pain would reduce the time to analgesic administration in a mixed adult and pediatric emergency department (ED).
  
  
  METHODS
  A protocol for IN fentanyl (1.5 microg/ kg) for children age 1-15 years presenting with acute pain was introduced to the department. All children who received intravenous (IV) morphine in the 7 months prior to the introduction of the protocol and either IV morphine or IN fentanyl in the 7 months after the introduction of the protocol were identified from drug registers. Time to analgesic administration, time to see a doctor, and the ages of patients were compared between the periods before and after the introduction of IN fentanyl.
  
  
  RESULTS
  Following implementation, 81 patients received IN fentanyl and 37 received IV morphine, compared to 63 patients receiving morphine in the previous 7 months. The median time to analgesic administration for IN fentanyl was significantly shorter than for morphine (32 minutes vs. 63 minutes, p = 0.001). Children receiving fentanyl were significantly younger than those receiving morphine (median = 8.5 years vs. 12 years, p < 0.001).
  
  
  CONCLUSIONS
  This study demonstrates that children treated with IN fentanyl received analgesic medication faster than those treated with IV morphine in a mixed ED. Younger children were more likely to receive opioid analgesia following the introduction of fentanyl.
authors.affiliation: Department of Emergency Medicine, Liverpool Hospital, Sydney, Australia. anna.holdgate@swsahs.nsw.gov.au
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.forename: Anthony
authors.initials: A
authors.lastname: Cao
authors.forename: Ka Mei
authors.initials: KM
authors.lastname: Lo
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl