Triage-nurse initiated intranasal fentanyl (INF) is a feasible analgesic option in patients with fractured necks of femur.

Triage-initiated INF is associated with more rapid time to analgesic administration and decreased length of stay in the ED.

These findings are relevant in overcrowded EDs to provide early analgesia and improve clinical decision-making and ED flow.

Pain relief is a priority for patients with hip fractures who present to Emergency Departments (EDs). Intranasal fentanyl (INF) is an ideal option for nurse initiated analgesia as it does not require intravenous access and can expedite care prior to examination by a physician.

Pain relief in patients with hip fractures is delayed during episodes of ED crowding.

A retrospective medical record review was conducted following introduction of an INF guideline in an adult ED in 2018. Patients were included over a 4-month period during which the guideline was introduced. Historical and concurrent control groups receiving usual care were compared to patients receiving INF.

This quality improvement initiative investigated whether an INF analgesia at triage guideline would decrease time to analgesic administration in adults with hip fracture in ED.

This study included 112 patients diagnosed with fractured hips of which 16 patients received INF. Background characteristics were similar between groups. Mean time to analgesic administration (53 v 110 minutes), time to x-ray (46 v 75 minutes), and ED length of stay (234 v 298 minutes) were significantly decreased in the intervention group. Inadequate documentation was a limiting factor in determining improved efficacy of analgesia.

Use of triage-initiated INF significantly decreased time to analgesic administration, time to imaging and overall length of stay in ED.

Emergency medicine

Analgesia

Fentanyl

Nasal aerosol

Hip fractures

© 2024 The Author(s). Published by Elsevier Ltd.