Purpose There 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 Methods From 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.

Results Seven of 8 participants had experience administering IN ketamine to children for procedural sedation. Nurses perceived that IN ketamine had the potential to reduce children’s 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.

Conclusions We 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 Implications Provider education should focus on IN ketamine’s 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.

What is known about the topic?

What did this study find?

Why does this study matter to clinicians?

Meetings Pediatric 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)

The authors have declared no competing interest.

The study was funded by Lawson Health Research Institute

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Western University Health Sciences Research Ethics Board

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Conflict of Interest The authors have no financial relationships relevant to this article to disclose. Shannon Scott is supported by a Canada Research Chair and a Distinguished Researcher Award from the Stollery Science Lab program at the Women and Children’s Hospital Research Institute.

Funding Statement This work was supported by a grant from the Lawson Health Research Institute

All data produced in the present work are contained in the manuscript