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Transcript FinelySpr15x
Sedation is a continuum of care. Pediatric patients bring unique
considerations for diagnostic testing and imaging in the community, a
low volume high risk population. Creating a process whereby providers
develop expertise and education in the care of pediatric patients and
families ensures cooperation for accurate test results and less repeat of
procedures related to inadequate sedation or sedation failure.
Create a process where by safe and effective sedation could be
provided in a community hospital setting
Review of current processes by a team of multidisciplinary providers
Establishment of an expert core group of practitioners
Ongoing evaluation of patient outcomes based on standard procedures
Consideration of Age and Developmental Level
Minimize discomfort and pain
Control Anxiety
Minimize psychological trauma
Control behavior and movement for safe completion of procedure
Return to a safe stage for discharge
Experience with children
Level of pediatric experience
Physiological and developmental differences in pediatrics
What type of sedation
Effective and safe dosing
Approach to the child
Where should it be done
Travel time
Community versus tertiary center
Chloral Hydrate
Versed – Intranasal, PO, IV
Recovery with expected side effects
Recovery with adverse events
Evidence to support correct dosing,
administration, and timing of procedure related to pharmacokinetics
Previous Situation – Nurse administered sedation
Current Situation – Anesthesiology administered sedation
Questions:
Need for sedation?
Provider?
Education?
Which medication?
Outcomes?
What is the best method of care for children in need of
echocardiogram?
Is sedation necessary and if so what is needed to
ensure the best care and the best outcomes?
What is the best medication and appropriate dose to
achieve safe and adequate sedation?
Members of the Pediatric Sedation Work Group
Cardiology
Pediatrics
Director of Nursing
Pediatric Nurse
Radiology Nurse
Emergency Department Clinical Educator
Echocardiography Technician
Doctor of Nursing Practice Student
Assess – need for change in practice
Link – problem interventions and outcomes
Synthesize – best evidence
Design – practice change
Implement and Evaluate - change in practice
Integrate and maintain – change in practice
Core Group of Nurses
Scheduling Guideline and Screening Process for Pediatric Minimal and
Moderate Sedation Non – Anesthesia
Pediatric Minimal and Moderate Sedation Non-Anesthesia Guidelines
PEDS Minimal or Moderate Sedation Order Set (RO-16) Physician’s
Orders
Patient Satisfaction Survey
Demographic
Age, Weight, ASA status, Procedure Type
Procedures Specific
Medication & Dose Administered
Delay in procedure Sedation or Scheduling Related
Complications/Adverse Events
Oxygen Desaturation
Respiratory Problems/Apnea
Vomiting
Arrest
Unexpected admission related
to sedation Complication
King, W., Stockwell, J., DeGuzman, M., Simon, H., & Khan, N. (2006). Evaluation of a pediatric-sedation service
for common diagnostic procedures. Academic Emergency Medicine, 13, 673-676.
Krause, B., & Green, S. (2006). Procedural sedation and analgesia in children. The Lancet, 230-235.
Doi:10.1016S0140-6736(06)68230-5.
Linder, J.M.B., & Schiska, A. (2007). Imaging children: tips and tricks. Journal of Radiology Nursing, 26(1), 23-25.
Lubisch, N., Roskos, R., & Sattler, S. (2008). Improving outcomes in pediatric procedural sedation. The Joint
Commission Journal on Quality and Patient Safety, 34(4), 192-195.
Piet, I., Leroy, J.M., Schipper, D., Hans, J., Knape, T.A. (2010). Professional skills and competence for safe and
effective procedural systematic review of the literature. International Journal of Pediatrics, 2010, 1-16.
Ruess, L., O’Connor, S., Mikita, C., & Creamer, K. (2002). Sedation for diagnostic imaging: use of pediatric and
nursing resources as an alternative to a radiology department sedation team. Pediatric Radiology, 32, 505-510.
Sandborn, P., Michna, E., Zurakowski, D., Burrows, P., Fontaine, P., Connor, L., & Mason, K. (2005). Adverse
cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations. Radiology,
237, 288-294.
Woodthorpe, C., Trugg, A., Gurney, A., Sury, M. (2007). Nurse led sedation for paedritic MRI: progress and issues.
Paediatric Nursing, 19(2), 14-18.
Yildirim, S.V., Guc, B.U., Bozdogan, N., & Tokel, K. (2006). Oral versus intranasal midazolam premedication for
infants during echocardiographic study. Advances in Therapy, 23(5), 719-724.
Acknowledgements
1
A special thanks to:
Mayo Clinic Health Systems Eau Claire
Pam White RN, MSN, Dr. Angela Stombaugh, Dr. Mary Zwygart-Stauffacher, Dr. Regis Fernandes, Debra White,
Jolinda Retzloff, RN, Suzanne Secraw, RN, Lisa Moelter RN, CPN, & My family for their support.