title: Time to opioid administration after implementation of an intranasal fentanyl protocol.
abstract: BACKGROUND
  Prompt and effective analgesia is a mainstay of emergency department (ED) medicine; however, it is often delayed in times of overcrowding and by the need to establish intravenous (IV) access. Thus, noninvasive analgesic administration by means of the intranasal route could potentially reduce time to analgesic administration by eliminating IV line insertion.
  
  
  METHODS
  This retrospective study evaluated time from physician entry into patient's room to opioid administration after implementation of an intranasal fentanyl protocol. Data were collected on pediatric patients who received intranasal fentanyl in the ED 225 days after protocol implementation. Time to opioid administration was then evaluated against historical controls given IV opioids in the same ED 90 days before protocol implementation.
  
  
  RESULTS
  Seven patients were included in the intranasal fentanyl group and were evaluated against 47 patients given IV opioids. Time from physician entry into patient's room to opioid administration was significantly reduced for intranasal fentanyl (20.43 ± 11.54 minutes) vs IV opioids (42.04 ± 31.55 minutes; P = .002), and IV line insertion was avoided in all 7 intranasal fentanyl patients. No significant differences in adverse events were noted.
  
  
  CONCLUSIONS
  This study provides evidence that administration of fentanyl via the intranasal route in the ED decreases time to administration of opioids in pediatric patients.
authors.affiliation: INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112. Electronic address: jared.a.schaefer@gmail.com.
authors.forename: Jared A
authors.initials: JA
authors.lastname: Schaefer
authors.affiliation: INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112. Electronic address: tamara.mlekoday@integrisok.com.
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Mlekoday
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D065386:Historically Controlled Study; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D061665:Time-to-Treatment
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl