Design and roll out of standardised approach to paediatric procedural sedation in Victorian emergency departments

Authors

  • Jan Pannifex,

    1. Department of Health, Emergency Care Improvement and Innovation Clinical Network, Commission for Hospital Improvement, Melbourne, Victoria, Australia
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  • Elif Cetiner,

    1. Department of Health, Emergency Care Improvement and Innovation Clinical Network, Commission for Hospital Improvement, Melbourne, Victoria, Australia
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  • Theresa Wilkie,

    1. Emergency Department, Sunshine Hospital, Melbourne, Victoria, Australia
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  • Anne-Maree Kelly,

    Corresponding author
    1. Department of Health, Emergency Care Improvement and Innovation Clinical Network, Commission for Hospital Improvement, Melbourne, Victoria, Australia
    2. Emergency Medicine, Western Health, Melbourne, Victoria, Australia
    • Correspondence: Professor Anne-Maree Kelly, Department of Health, Emergency Care Improvement and Innovation Clinical Network, Level 4/50 Lonsdale Street, Melbourne, Vic. 3000, Australia. Email: anne-maree.kelly@wh.org.au

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  • Paediatric Procedural Sedation Reference Group

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    • Emergency Care Improvement and Innovation Clinical Network (ECIICN), Department of Health, Victoria, Australia (see Acknowledgements).

  • Jan Pannifex, RN, Grad Dip Business, Manager; Elif Cetiner, BA (Hons), EMPA, Formerly Project Officer; Theresa Wilkie, BN, Project Officer; Anne-Maree Kelly, MD, FACEM, Senior Clinical Advisor, Academic Head.

Abstract

Objectives

Children sometimes require minor procedures in the ED for which sedation is needed. Information from Victorian EDs indicated that processes for paediatric procedural sedation were variable, both within and between health services. The aims of this project were to improve safety and reduce variation in practice with respect to paediatric procedural sedation in EDs by rolling out a standardised paediatric sedation programme in Victorian EDs.

Methods

The project was managed by a clinical network with support of an expert reference group; however, implementation was conducted at the local ED level. The approach was multi-modal and grounded in quality and safety theory. It included revision of evidence-based training materials, information sheets and risk assessment/procedure documentation forms, information on a child and family-centred approach, a before-and-after clinical governance assessment, and train-the-trainer activities. The project was evaluated by clinical audit of cases, analysis of before-and-after clinical governance assessments, numbers of staff completing training and credentialing, and qualitative feedback on the programme from ED staff.

Results

Fourteen EDs completed the project; 10 metropolitan and four regional/rural. Significant shifts in nine key clinical governance items were found, including structured training and credentialing, provision of parent information sheet, and monitoring of adverse events. The clinical audit showed >75% compliance, with seven indicators including recording of weight, fasting time and baseline observations, composition of sedation team, and documentation that discharge criteria were met. Nine hundred and seventy-one staff were trained within the project period.

Conclusion

This multi-modal implementation strategy has achieved clinical practice improvement across organisational boundaries.

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