Related Experiment Video
Updated: Jan 20, 2026
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Effect of a Sedation Weaning Protocol on Safety and Medication Use among Hospitalized Children Post Critical Illness
Jean C Solodiuk1, Christine D Greco1, Katherine A O'Donnell1
1Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
Insights
Implementing an evidence-based guideline reduced dangerous home sedative weaning in children. While mild withdrawal symptoms increased slightly, severe symptoms and hospital stays remained unchanged, improving patient safety.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Quality improvement initiatives
Background:
- Sedation is crucial for critically ill children's ventilation, safety, and comfort.
- Prolonged sedation can lead to tolerance, dependence, and withdrawal syndrome.
- Medication errors during outpatient weaning pose risks to children.
Purpose of the Study:
- To enhance the safety of pediatric patients undergoing sedative weaning.
- To reduce medication errors associated with parent-administered outpatient sedation weaning.
Main Methods:
- Retrospective analysis guided by Plan-Do-Study-Act quality improvement cycles.
- Development and implementation of an evidence-based post-PICU sedation weaning guideline.
- Pre- and post-implementation evaluation with ongoing staff education.
Main Results:
- Significant reduction in patients discharged on home opioids and benzodiazepines (11% to 3%).
- Decreased discharge rates for methadone weaning (7% to 0%).
- Increased mild-moderate withdrawal symptoms (11% to 21%), with consistently low severe withdrawal rates (0.6% to 1%).
- No significant change in median hospital length of stay.
Conclusions:
- An evidence-based post-PICU weaning guideline effectively reduced discharge on dangerous medications.
- The guideline led to a modest increase in mild-moderate withdrawal symptoms without increasing severe symptoms or length of stay.
- This approach improves the safety of children weaning from sedatives.
Background:
Best practice guidelines for the safe and compassionate care of critically ill children necessitates the use of sedation to ensure adequate ventilation, patient safety and comfort. Prolonged use of sedation can result in tolerance, physical dependence and iatrogenic withdrawal syndrome if medications are weaned too quickly.
Problem:
In the context of medication errors related to parent administration of outpatient sedation weans, we set out to improve the safety of children weaning from sedatives.
Methods:
A retrospective analysis was completed. Quality improvement was guided by using Plan-Do-Study-Act cycles.
Interventions:
An evidence-based post PICU sedation weaning guideline was created and implemented over time with ongoing education, and review of progress with staff members with pre-post evaluation.
Results:
Post intervention, there were significant differences in the numbers of patients discharged on home weaning from both opioids and benzodiazepines (11%, n = 24/219 pre; 3%, n = 7/233 post; p < 0.005). The number of patients discharged with a methadone wean decreased (7%, n = 16/219 pre; 0%, 0/233 post; p = 0.03). Despite these differences, there were no significant differences in the median hospital length of stay (42 pre; 39 post; p = 0.35). Post implementation more children had mild to moderate symptoms of withdrawal (11% pre; 21% post; p < 0.005) as compared to pre-implementation, however, the percentage of severe symptoms remained consistently low (0.6% pre; 1% post; p = 0.11).
Conclusions:
Implementation of an evidence-based post PICU weaning guideline significantly reduced the number of patients discharged on potentially dangerous medications with modest increases in mild-moderate symptoms of withdrawal and no significant change in length of stay or the incidence of severe symptoms of withdrawal.
Related Concept Videos
07:27How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
09:17Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness
13:54Fundamentals of Breeding and Weaning
Millions of mice and rats are bred for use in biomedical research each year. Worldwide, there are several large commercial breeding facilities that supply mice to research laboratories, but many facilities choose to also breed mice and rats in-house to reduce costs and increase research options. When breeding in the animal facility, researchers are able to manipulate the genetics of the...
00:59Hospitals-II
Nurses that work in...
07:35Safety Checks and Ten Rights of Medication Administration
01:28Hospitals-I