Adelgais KM, et al. - This study was planned to assess the change in three Institute of Medicine quality indicators (timeliness, safety, and effectiveness) in the pediatric emergency department (ED) after the introduction of the Mucosal Atomizer Device Nasal (MADn) for opioid analgesia. Findings suggested that compared to intravenous opioid (IVO) in the setting of the pediatric ED, intranasal fentanyl (INF) was associated with improved timeliness and equivalent effectiveness and safety.

Methods

• Researchers undertook a retrospective review of patients receiving opioid analgesia for certain conditions over a 5-year period.
• A comparison of patients receiving intravenous opioid (IVO) to those receiving intranasal fentanyl (INF) was performed.
• In this study, timeliness outcomes included time from medication order to administration, time from dose to discharge, overall time to analgesia, and ED length of stay.
• Change in pain score and frequency of repeat dosing were included in effectiveness outcomes.
• Safety outcomes included the frequency of reversal agent administration or a documented oxygen desaturation of < 90%.
• To evaluate the effect of moderate sedation on all three outcomes, they performed sensitivity analyses.

Results

• 1702 patients received opioid analgesia during the study period; 744 before and 958 after MADn introduction, of whom, 233 (24%) received INF.
• After MADn introduction, shorter time to discharge from dose (109 vs. 203 min; p < 0.05) and shorter ED length of stay (168 vs. 267 min; p < 0.05) were evident among patients receiving INF.
• No difference in pain score reduction was observed; however, repeat dosing was less frequent for patients receiving INF (16% vs. 27%).
• Findings revealed no use of reversal medication and no difference in the frequency of oxygen desaturations.
• On excluding patients undergoing moderate sedation from the analysis, no difference was observed in the direction of findings for all three outcomes.