Paediatric Sedation
Aims and objectives
- To quantify and evaluate the quality of current sedation practice beyond the anaesthetic/operating-room setting by auditing sedation episodes, initially in the tertiary setting, then following-up in district and rural settings throughout HNEAHS and NCAHS.
- To develop a process for the delivery of safe sedation to children outside the anaesthetic/operation setting; including evidence based clinical practice guidelines, documentation tools, education resources and healthcare strategies.
Method
- A review of the literature and contact with other tertiary paediatric services in Australia regarding any existing documentation around sedation has been undertaken prior to determining the need for this project.
- A steering group has been formed with representation from an appropriate mix of disciplines, geographical sites and levels of paediatric care within HNEAHS. This group plans to survey services (tertiary and non-tertiary) across the area to establish existing practices, educational and clinical guidelines and documentation, strengths and needs. This group would be expanded to incorporate wider representation across the entire NCHN. This needs analysis will inform guideline development that will remain relevant to a wide range of paediatric practice settings and practitioners.
- Quantitative and qualitative audit tools have been developed and used in JHCH to quantify and evaluate current sedation practice beyond the anaesthetic/operating room setting. These audits will be repeated throughout HNEAHS and NCAHS facilities that manage children in either Emergency or Paediatric settings. Feedback to staff will be provided in the form of a one page document which will be made available to the NUM on completion of the analysis.
- A resource document and clinical practice guidelines incorporating Australian standards and guidelines for paediatric procedural and diagnostic sedation outside of the operating room will be written to standardise and guide practice at a local level across multiple specialties and healthcare facilities.
- A “Record of Sedation” duplicate form will be designed to include the following: Part A -the sedation consent and pre-sedation assessment; Part B - sedation prescription, sedation procedure, observation record, recovery record, critical incident record and discharge readiness assessment. These duplicate forms will allow for the collection of extensive quantitative and qualitative data on all paediatric procedural sedation episodes outside of the operating room; provide a legal record of the sedation episode for the medical record; and a copy for audit and research purposes.
- Educational in-service programs will be provided to introduce the new documentation, guidelines and practice requirements to clinicians across all relevant sites within HNEAHS and NCAHS.
- A retrospective comparison of pre and post implementation audit data to evaluate the interventions will be carried out.
- Project results will be presented to the Executives of the HNEAHS, NCAHS and NCHN.
Key performance indicators
The success of the project will be measured by:
- Pre and post implementation audit data evaluation as evidenced by:
- improved pre-sedation screening with appropriate practitioner skill level matched to ASA patient score. Aim = 100% compliance.
- improved sedation prescription for required outcome as evidenced by sedation duration and depth. Aim = a 50 % reduction in incidents of prolonged or inadequate sedation detected by audit.
- improved inter-departmental (within health facility) transport practice with the required safety equipment used for every transport of a sedated child. This may expand to include improved transport of sedated children between health facilities and external imaging services, since this has been raised as a possible area of risk/need by members of the steering group (to be further investigated). Aim = 100% compliance.
- IIMs reports around sedation incidents will be examined by the Paediatric Sedation Committee. A reduction in the actual incidence of sedation mishaps is desired, however IIMs data around sedation incidents is currently under-reported as evidenced by the pre-implementation audit. The committee will be encouraging IIMs reporting, and will be reporting incidents subsequently discovered, so it is expected that initially there will be a reporting spike.
Progress
- Paediatric Sedation Committee meetings have occurred to develop the Paediatric Sedation Clinical Practice Guideline.
- The project funding has now concluded but work continues within the scope of the team's clinical positions.
- We are awaiting the review and approval of the final drug protocols through the HNELHD Quality Use of Medicines Committee, before inserting them into the Clinical Practice Guideline and seeking it's approval through the relevant HNE Clinical Streams and Network.
For more information contact:
Dr Susie Lord
Staff Specialist Pain Medicine
Kaleidoscope & Division of Anaesthesia, Intensive Care & Pain
Management
Phone: 02 4922 3435 (secretary)
or
Elizabeth Kepreotes (Clinical Improvement Facilitator, Kaleidoscope - John Hunter Children’s Hospital)
Phone: 02 4985 5539