1. Methods The initial audit was carried out retrospectively, looking at the acute paediatric presentations from January 2014 to May 2014 inclusive. Patient names and times of intranasal fentanyl administration were obtained from the controlled substances book. Patient notes were located and used to obtain date of births, presenting complaints and times of arrival. The time of arrival used was time of patient’s first contact with Emergency Department staff i.e. check in at reception. The times of arrival were compared to time of analgesia administration. A time to analgesia of ten minutes was set as the departments pre-set target The results of the initial audit were presented to clinical and non clinical staff in the department along with information on intranasal fentanyl. Patient information posters were created and distributed throughout the department waiting areas to increase parental knowledge. The audit was repeated with acute paediatric patients presenting from April 2015 to June 2015 inclusive. CONCLUSION Intranasal Fentanyl is safe, easily tolerated and does not require IV access. It is a safe and effective analgesic choice for acute paediatric presentations in an Emergency Department. Our audit and subsequent presentation of results has led to increased awareness of its potential advantages. Usage has drastically increased in our department as a result. Despite an overall decrease in time to administration there is still room to improve to meet our pre- set standards.. Discussion Acute paediatric presentations to Emergency departments are common, representing up to a third of all patients. A major proportion of these presentations involve an acute injury or acute pain. The paediatric group represents a unique cohort of patients who require special care and consideration during there visit to the emergency department. Prompt recognition and adequate treatment of a child’s pain is essential. Difficulties providing efficient analgesia arise from prolonged waiting times and overworked medical staff. Effective analgesia is also often difficult in this age group secondary to inappropriateness of invasive administration methods. Our department adopted Intranasal Fentanyl as a solution to both problems. It provides a quick, effective, non invasive form of analgesia which can be administered using a nurse driven protocol. We found during the initial audit that fentanyl was being greatly under utilised. Reasons for this were lack of medical staff familiarity with or confidence in using essentially a strong opioid in a paediatric group, we also found clerical staff and patient knowledge of this treatment option was minimal. We found that time to administration of analgesia was far longer than desirable in the group of patients who did receive intranasal fentanyl, this showed slow recognition of suitable children by department staff. Following the presentation of initial results to clinical and non clinical staff along with safety and effectiveness data, the usage of intranasal fentanyl was found to have increased drastically from an initial figure of 19 patients in five months to 49 over a three month period. Time to analgesia improved moderately with average time to analgesia improving from 64 to 51 mins. This is an area which can be improved further by quick administration of analgesia based on clinical signs of pain/ injury rather than radiology results. These signs need to be flagged immediately by parents or clerical staff once a patient arrives to the department in moderate to severe pain. INTRODUCTION Paediatric presentations make up 30% of all patients presenting to Sligo Regional Hospital Emergency Department. Many of these patients are presenting with acute injuries or other causes of acute pain. The Paediatric population is a highly sensitive group to both pain and hospital exposure, they should be made feel as comfortable as possible by medical staff during their stay. It is imperative that this group receive prompt and effective analgesia when needed but choices are limited to non invasive methods of administration where possible. Intranasal Fentanyl has been recommended for moderate to severe pain and is easily administered but has not yet become common practice in many Irish emergency departments. Aim We aimed to investigate the efficient usage of intranasal fentanyl in acute paediatric presentations to Sligo Regional Hospital emergency department. We hoped to improve our staff’s awareness and confidence to administer intranasal fentanyl as a quick, effective and safe analgesia Time to Intranasal Fentanyl in Acute Paediatric Presentations to an Emergency Department, A Closed Loop Audit Dr Stephen Gilmartin, Emergency medicine SHO, Sligo Regional Hospital Dr Lisa Cunningham, Emergency Medicine SPR, Sligo Regional Hospital Dr Adrienne Rodgers, Emergency Medicine SHO, Sligo Regional Hospital Dr Michael Sweeney, Emergency Medicine Consultant, Sligo Regional Hospital Results In the Initial audit period 19 children were identified as having received intranasal fentanyl following presentation with acute pain/injury. 18 presentations were musculoskeletal in nature with the other patient presenting with a burns injury. Distal radius and ulnar fractures were the most common injury with 9 presentations. Three of the patients during the initial audit period received analgesia within the target time of ten minutes. The Average time to analgesia for this period was 64 mins. During the second audit period 49 patients received intranasal fentanyl for acute presentations. Forty one of these patients had musculoskeletal injury with 19 of these injuries involving radius and ulna. Of the nine patients with non- musculoskeletal injury four presented with burns. Two patient arrival times could not be determined and were removed from the average time to administration figures. Six of the patients in the second audit period received intranasal fentanyl within the time to analgesia target. The Average time to analgesia during this period was 51 mins.