A qualitative study of emergency nurses perspectives on intranasal ketamine for procedural sedation in children

PurposeThere is mounting evidence supporting a role for intranasal (IN) ketamine for procedural sedation in children due to its less invasive delivery. Drug administration and monitoring is largely performed by nurses and clinical uptake requires understanding their perceptions. We explored nursing perspectives of IN ketamine for procedural sedation in children to understand facilitators and barriers and inform institutional guidelines. Design and MethodsFrom January to February, 2018, we conducted 2 focus groups with 8 registered nurses in a Canadian tertiary care paediatric ED. Following professional transcription, data were analyzed using an inductive qualitative approach. ResultsSeven of 8 participants had experience administering IN ketamine to children for procedural sedation. Nurses perceived that IN ketamine had the potential to reduce childrens distress and improve nursing resource use. Perceived barriers included: 1) uncertainty regarding sedation effectiveness and incorporation into institutional sedation protocols, 2) perceptions that IN ketamine produced a relatively lighter, slower-onset, and less titratable sedation, and 3) healthcare providers lack of familiarity with IN ketamine and reluctance to change their current approach to sedation. ConclusionsWe identified barriers to adoption of IN ketamine such as uncertainty regarding its pharmacodynamic properties, safety, and impact on workflow, along with facilitators such as fewer adverse events and nursing resources, and less procedural distress for children. Practice ImplicationsProvider education should focus on IN ketamines pharmacodynamic properties and development of institutional sedation guidelines that define indications for use, support engagement of child life specialists, and operationalize the type and duration of monitoring requirements. CLINICIANS CAPSULEO_ST_ABSWhat is known about the topic?C_ST_ABSO_LIIntranasal ketamine is an emerging agent for procedural sedation and analgesia in the emergency department due to ease of administration. C_LI What did this study ask?O_LIWhat are paediatric nurses perspectives on intranasal ketamine for procedural sedation among children in the emergency department? C_LI What did this study find?O_LINurses identified advantages to intranasal ketamine but expressed considerable uncertainty regarding its pharmacodynamic properties and its incorporation into clinical practice. C_LI Why does this study matter to clinicians?O_LIProvider education may overcome some uncertainty and should focus on intranasal ketamines pharmacodynamic properties and incorporation into institutional sedation protocols. C_LI MeetingsPediatric Academic Societies (Baltimore, Maryland, April 30, 2019); Canadian Association of Emergency Physicians (Halifax, Nova Scotia, May 29, 2019); Canadian Paediatric Society (Toronto, Ontario, June 7, 2019)