title: Evaluation of a paediatric procedural sedation training and credentialing programme: sustainability of change.
abstract: BACKGROUND
  An ongoing comprehensive paediatric procedural sedation (PPS) training and credentialing programme to improve patient safety was introduced into emergency departments (EDs) at a tertiary children's hospital (Royal Children's Hospital; RCH) and a suburban mixed ED (Sunshine Hospital; SH) in Melbourne, Australia. The study aimed to establish whether changes in practice had been sustained 3 years after implementation of the PPS programme.
  
  
  METHODS
  100 PPS episodes were identified at both hospitals (50 at each hospital) pre-implementation, 6 months and 3 years after implementation. This study retrospectively analysed 11 proxy markers of sedation safety by review of prospectively collected sedation records and medical records. Performance during the three time periods was compared using chi(2) testing.
  
  
  RESULTS
  Average age was 6 years and sedations were mainly for fracture reduction and laceration repair. Nitrous oxide and ketamine were the most commonly used agents. Midazolam use decreased over the study period. Six months after implementation at both hospitals relevant proxy markers of sedation safety were significantly improved over the pre-implementation level. Three years after implementation markers of sedation safety were still improved over pre-implementation levels. However, based on a minimum compliance with seven of 11 sedation safety markers both sites deteriorated; RCH from 96% to 80% (p=0.028) and SH from 68% to 32% (p=0.001).
  
  
  CONCLUSIONS
  Based on an analysis of proxy markers of sedation safety significant changes over pre-implementation sedation care were maintained 3 years after implementation of a PPS programme. Documentation of sedation safety markers decreased over the study period, more so at the community hospital. To maintain educational gains and system change in sedation safety requires ongoing resources.
authors.affiliation: University of Melbourne, Emergency Department, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. franz.babl@rch.org.au
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
authors.forename: David
authors.initials: D
authors.lastname: Krieser
authors.forename: Julie
authors.initials: J
authors.lastname: Belousoff
authors.forename: Theane
authors.initials: T
authors.lastname: Theophilos
mesh_terms: D000776:Anesthesiology / Q000193:education*; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D003406:Credentialing; D004636:Emergency Service, Hospital; D006801:Humans; D010372:Pediatrics / Q000193:education*; D015397:Program Evaluation; D014739:Victoria