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Evaluation of the impact of a paediatric procedural sedation credentialing programme on quality of care

Authors


  • Stephen Priestley, MB BS, FACEM, Director Emergency Department; Franz E Babl, MD, MPH, FRACP, FAAP, Consultant Emergency Paediatrician; David Krieser, MB BS, FRACP, Consultant Emergency Paediatrician; Andrew Law, MB BS, Fellow in Emergency Medicine; Joanne Miller, RN, Nurse Educator; Maureen Spicer, PhD, Research Coordinator; Melissa Tully, RN, Nurse Educator.

Dr Franz E Babl, Emergency Department, Royal Children’s Hospital, Parkville, Victoria 3052, Australia. Email: franz.babl@rch.org.au

Abstract

Objectives:  The aim of the present study is to describe changes in documentation, risk assessment and patient care resulting from implementation of a credentialing process for medical and nursing staff in paediatric procedural sedation (PPS) in two EDs – one an urban mixed ED and the other a specialist paediatric ED.

Methods:  Chart review of 100 patients undergoing PPS prior to and 100 patients following introduction of the PPS programme. Information was extracted from medical records and sedation checklists. Demographics, drugs used, procedure performed and elements of the pre-procedural, intra-procedural and post-procedural care were compared pre- and post implementation of the PPS programme.

Results:  Significant improvements in the post-implementation period compared with pre-implementation were seen in: frequency of documentation of informed consent (87 vs 15%, P < 0.0001); evidence of performance of a pre-procedural risk assessment (87 vs 1%, P < 0.0001); and appropriate recording of vital signs (58 vs 27%, P < 0.0001). Improvements were also noted in documentation of weight, allergies, fasting status and recording of drug orders. There were no adverse events recorded in the pre-programme period and 6 recorded in the post-programme period.

Conclusion:  The implementation of a PPS credentialing programme into these two EDs resulted in significant improvements in risk assessment, monitoring and documentation of important information related to safe PPS. These improvements should result in improved quality and safety of PPS.

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