Improving outcomes in pediatric procedural sedation.
BACKGROUND
In Fall 2003, Chris Evert Children's Hospital (CECH; Fort Lauderdale, Florida) exclusively used chloral hydrate for moderate sedation. As procedures became longer and more complex, pentobarbital became the primary sedative used. Yet children receiving pentobarbital were awakening during the procedure from paradoxical drug reactions or insufficient sedation. In 2003, the failed sedation rate was 12.29%--more than six times the national benchmark of 2%.


METHODS
The pediatric sedation team created a pediatric sedation protocol, which reflected the designation of an a2-adrenergic agonist, dexmedetomidine (dex), as the drug of choice and spearheaded a variety of performance improvement changes, including creation of a stand-alone eight-bed sedation unit to accommodate the registration process and pre-assessment and postprocedure monitoring and to include the parent in the treatment continuum.


RESULTS
Following the implementation of the new protocol in 2003, the failed sedation rate for children undergoing various diagnostic and therapeutic procedures decreased from 12.29% to 1.63% in 2004, 0.19% in 2005, and 0.28% in 2006; in 2007 the rate was 0.72%--reflecting an average 98% reduction in the failed sedation rate.


CONCLUSIONS
The continued improvement and success in pediatric sedation over time indicates that the protocol has sustained benefits and lasting value.
Lubisch
Nina
N
Chris Evert Children's Hospital, Fort Lauderdale, Florida, USA.
Roskos
Rudolph
R
Sattler
Suzan M
SM
D000293:Adolescent; D001363:Awards and Prizes; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods / Q000592:standards*; D005431:Florida; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care / Q000639:trends; D010348:Patient Care Team / Q000458:organization & administration; D017211:Treatment Failure