Nitrous Oxide Use For Minor But Painful Pediatric Procedures

Problem: Nitrous oxide (N2O) is used for mild to moderate pain control and anxiolysis. Registered nurses (RN) as providers of N2O administration may decrease the number of missed opportunities for pain control or anxiolysis. The purpose of this quality improvement initiative was to evaluate the type of procedures and rate of N2O administration by providers, and cost difference between them. Method: A descriptive, cohort-design for pediatric patients in the Imaging and Sedation Department between October through November of 2017 and 2018. Data was compared between physicians in 2017 and either a physician or RN administered gas in 2018. Results: A total of 197 (N=197) patients received N2O. In 2017, there were 93 patients (n=93) and in 2018, there were 104 patients (n=104). In 2017, only physicians (n=93; 100%) delivered the gas. In 2018, 41 RNs (n=41; 39%) and 63 physicians (n=63; 61%) delivered the gas. The difference between providers was not significant (t=2; p = .875); hence, the addition of RNs did not change the number of patients receiving N2O. The most common procedure for physician delivery was botox injection while the most common procedure for RNs was intravenous catheter insertion. Finally, reimbursement was greater when a physician delivered the gas versus the RN. Implications for Practice: The number of administrations by physicians decreased once RNs were administering N2O. However, there was still an increase in the amount of pediatric patients receiving N2O between the two cohorts studied. The use of N2O in minor but painful procedures is encouraged