{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:25:13Z","timestamp":1787239513190,"version":"build-2736575974"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015. Patients were divided into 4 groups: (1) received INF on the pathway appropriately; (2) \u201cmissed opportunities\u201d to receive INF, defined as either INF was ordered and then subsequently canceled (for pain ratings, \u22656\/10), or INF was ordered, cancelled, and intravenous (IV) morphine given, or INF was not ordered and a peripheral IV line was placed to give IV morphine as first-line medication; (3) peripheral IV established upon ED arrival; (4) no pain medication required. Additionally, a survey regarding practice habits for pain management was completed to evaluate physician barriers to utilization of the pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1374 patients met the inclusion criteria. Missed opportunities were identified 41% of the time. Neither younger patient age nor more years of physician experience in the ED were associated with increased rates of missed opportunities. The survey (95% response rate) revealed greater comfort with and preference for IV morphine over INF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high rate of missed opportunities, despite the implementation of an INF pain pathway, indicates the need for further exploration of the barriers to utilization of the INF pain pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000001375","type":"journal-article","created":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T19:16:08Z","timestamp":1512155768000},"page":"473-478","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating the Implementation Barriers of an Intranasal Fentanyl Pain Pathway for Pediatric Long-Bone Fractures"],"prefix":"10.1097","volume":"34","author":[{"given":"Tamara","family":"Arnautovic","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Sommese","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Eastern Virginia Medical School;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Mullan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Barron","family":"Frazier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turaj","family":"Vazifedan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana Erikson","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230930","first-page":"1","article-title":"Intranasal fentanyl for the management of acute pain in children","volume":"10","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"bib2-20230930","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/MOP.0000000000000347","article-title":"Management of acute pediatric pain in the emergency department","volume":"28","year":"2016","journal-title":"Curr Opin Pediatr"},{"key":"bib3-20230930","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/j.1553-2712.2010.00905.x","article-title":"Use of 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