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


CONCLUSIONS
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.
Priestley
Stephen
S
Emergency Department, Sunshine Hospital, Melbourne, Victoria, Australia.
Babl
Franz E
FE
Krieser
David
D
Law
Andrew
A
Miller
Joanne
J
Spicer
Maureen
M
Tully
Melissa
M
D002648:Child; D016292:Procedural Sedation / Q000592:standards; D003406:Credentialing; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008485:Medical Audit; D010372:Pediatrics / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D018570:Risk Assessment