Intranasal diamorphine for paediatric analgesia in the Accident and Emergency Department: lessons learned from the development, audit and re-audit of an integrated care pathway

The objective of this study was to introduce intranasal diamorphine for paediatric analgesia in the Accident and Emergency (A&E) Department and to monitor its use. It was carried out at the A&E Department of a District General Hospital. An integrated care pathway was developed, drawing on both the evidence base for intranasal diamorphine use and extant guidelines for emergency analgesia in the paediatric age group. Implementation, audit and modification of the care pathway were undertaken, followed by re-audit to complete the audit cycle. The integrated care pathway proved easy to use, but audit showed that documentation of parameters of care was inadequate. A clinical proforma was added to the care pathway to ensure adequate data capture, and re-audit showed significant improvement in documentation. In conclusion, this integrated care pathway for the use of intranasal diamorphine for paediatric analgesia may be of general applicability in A&E Departments.