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Evaluation of a paediatric procedural sedation training and credentialing programme: sustainability of change
Franz E Babl1, David Krieser, Julie Belousoff
1University of Melbourne, Emergency Department, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. franz.babl@rch.org.au
Insights
Paediatric procedural sedation (PPS) safety improved 6 months after a training program. While improvements were sustained at 3 years, documentation compliance decreased, highlighting the need for ongoing resources to maintain patient safety.
Area of Science:
- Emergency Medicine
- Patient Safety
- Pediatric Sedation
Background:
- A comprehensive paediatric procedural sedation (PPS) training and credentialing program was implemented in two Australian hospitals to enhance patient safety.
- The program was introduced in a tertiary children's hospital (RCH) and a suburban mixed emergency department (ED) (SH).
Purpose of the Study:
- To evaluate the long-term sustainability of practice changes 3 years after the implementation of the PPS program.
- To assess whether improvements in sedation safety markers were maintained over time.
Main Methods:
- A retrospective analysis of 100 PPS episodes (50 per hospital) at three time points: pre-implementation, 6 months, and 3 years post-implementation.
- Evaluation of 11 proxy markers of sedation safety using prospectively collected sedation and medical records.
- Statistical comparison of performance across the three time periods using chi-squared testing.
Main Results:
- Six months post-implementation, significant improvements in sedation safety markers were observed at both hospitals compared to baseline.
- At 3 years, sedation safety markers remained improved compared to pre-implementation levels.
- However, compliance with a minimum of 7 out of 11 safety markers decreased significantly at both RCH (96% to 80%) and SH (68% to 32%) by the 3-year mark.
Conclusions:
- The PPS program led to sustained improvements in sedation safety over 3 years.
- A notable decline in the documentation of sedation safety markers occurred, particularly in the suburban hospital.
- Ongoing resources are essential to maintain educational gains and system-wide improvements in paediatric procedural sedation safety.
Introduction:
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.
Method:
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).
Conclusion:
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.
