Evaluation of a paediatric procedural sedation training and credentialing programme: sustainability of change

Abstract

Introduction An ongoing comprehensive paediatric procedural sedation (PPS) training and credentialing programme to improve patient safety was introduced into emergency departments (EDs) at a tertiary children's hospital (Royal Children's Hospital; RCH) and a suburban mixed ED (Sunshine Hospital; SH) in Melbourne, Australia. The study aimed to establish whether changes in practice had been sustained 3 years after implementation of the PPS programme. Method 100 PPS episodes were identified at both hospitals (50 at each hospital) pre-implementation, 6 months and 3 years after implementation. This study retrospectively analysed 11 proxy markers of sedation safety by review of prospectively collected sedation records and medical records. Performance during the three time periods was compared using c 2 testing. Results Average age was 6 years and sedations were mainly for fracture reduction and laceration repair. Nitrous oxide and ketamine were the most commonly used agents. Midazolam use decreased over the study period. Six months after implementation at both hospitals relevant proxy markers of sedation safety were significantly improved over the pre-implementation level. Three years after implementation markers of sedation safety were still improved over pre-implementation levels. However, based on a minimum compliance with seven of 11 sedation safety markers both sites deteriorated; RCH from 96% to 80% (p¼0.028) and SH from 68% to 32% (p¼0.001). Conclusion Based on an analysis of proxy markers of sedation safety significant changes over pre-implemenation sedation care were maintained 3 years after implementation of a PPS programme. Documentation of sedation safety markers decreased over the study period, more so at the community hospital. To maintain educational gains and system change in sedation safety requires ongoing resources.Procedural sedation and analgesia for painful and distressing interventions in children has become a standard tool for clinicians in the emergency setting.

Intranasal Fentanyl and High‐concentration Inhaled Nitrous Oxide for Procedural Sedation: A Prospective Observational Pilot Study of Adverse Events and Depth of Sedation

“…PSA was performed using standardized presedation assessment, monitoring during the procedure, and postsedation discharge criteria. As part of standard sedation practice, a sedation checklist, which forms part of the medical notes, was used 16,17 . For N 2 O sedation, minimum ED fasting times for solids and liquids were 2 hours 15 .…”

The important role of simulation in sedation

“…At 6-month follow-up, the training had significantly improved proxy markers of patient safety but at 3-year follow-up, there was deterioration in proxy markers of patient safety in both locales, although less at the academic hospital [26]. Schneeweiss compared self-directed learning sedation providers with a group that received simulation-based sedation training.…”

Procedural pain in children: education and management. The approach of an Italian pediatric pain center

“…Methods for teaching non-anesthesiologist pediatricians to manage sedation-analgesia have been discussed in the international literature [6,24,27,34]. Our model includes both frontal education and experience-based training.…”