Pediatric sedation course make procedures safer
With education, ED staff are 'on the same page'
Would you like to increase your knowledge and confidence in caring for children undergoing procedural sedation?
"Whether it is the nurse's first or 50th time doing a sedation, all the necessary steps and checks need to be done like it was their first," says Michele Morin, RN, MSN, clinical nurse specialist for emergency services at Children's Hospital Boston.
After a pediatric procedural sedation program was implemented at the Hospital for Sick Children in Toronto, random chart audits showed that almost all procedural sedations are being performed according to the ED's protocol.1 Savithiri Ratnapalan, MBBS, MEd, MRCP, FRCPC, FAAP, the study's lead author and an ED staff physician at the hospital, says, "I believe the success of the program is due to team learning and teamwork. It is a shared responsibility for sedation."
Here are the steps that were taken:
• Needs assessment surveys and focus group interviews were conducted by the two ED physicians, to identify educational needs of ED staff. Four group sessions were held in the ED conference room, with two physician groups and two nursing groups. "Results of the focus groups were used to develop the content and format of the sedation course," says Ratnapalan.
• All ED nurses and physicians attended a half-day sedation course given by Ratnapalan and another ED physician, and completed a multiple-choice examination. Below are the course objectives:
— discuss pediatric emergency procedural sedation guidelines;
— identify common sedative agents including indications and side effects;
— recognize potential complications that may occur as a result of emergency procedural sedation;
— identify innovative strategies for procedural pain management.
• Pediatric sedation guidelines for the emergency department were developed, based on practice guidelines from the American Association of Pediatrics, the American College of Emergency Physicians, and the American Society for Anesthesia.
Linette Margallo, RN, BScN, advanced nursing practice educator for the Division of Pediatric Emergency Medicine, thinks it is important that all new staff attend this pediatric sedation course. "I have received very good feedback from the new nurses after they attend this course," Margallo says. "They enjoyed the multidisciplinary approach, and the course content is very relevant to their practice."
The course allows nurses to be exposed to the same information that physicians are taught, which helps them understand why a particular medication is used, how to anticipate care needed, and how to address emergency situations, says Margallo. "Everyone is on the same page," she says. Nurses are able to advocate for appropriate resources to safely manage sedation in the ED, Margallo says. "They are familiar with the medications used and how children will recover from these medications," she says.
There also is a clearer understanding of individual roles, says Margallo. "The role clarity and consistency comes from the multidisciplinary approach to education," she says. "This is possible because all disciplines attend the same course: physicians, nurses, respiratory therapists, and child-life specialists."
At Children's Hospital Boston, ED nurses are required to attend a three-hour course about procedural sedation, says Morin. The course stresses the importance of safety for the patient and covers medication administration, end-tidal monitoring, emergency reversals, emergency interventions, and proper positioning during the procedure. Staff also must take an annual course developed by the hospital's sedation committee, and take a test with a passing grade of 80% or better.
"Nurses are also preceptored for one sedation," says Morin. "If they feel confident, have attended the didactic, and passed the online class, they are deemed competent." ED nurses do the following:
- Administer the drugs, with the physician present.
- Monitor the patient's cardiac status, end tidal, and blood pressure.
- Prepare the room with necessary emergency equipment.
- Complete the "timeout" verification procedures, and document this timeout on the patient's chart.
- Continue monitoring until discharge criteria are met.
Nurses document vital signs, the time of the first medication, the time the procedure was started, the level of sedation, any adverse effects, post-sedation discharge scores, education, and disposition. "The area that most frequently goes undocumented is who was given the discharge education and by whom," says Morin. "We stress the importance of complete documentation for all sedations." Compliance has improved with the implementation of online documentation, she adds.
Reference
- Ratnapalan S, Schneeweiss S. Guidelines to practice: The process of planning and implementing a pediatric sedation program. Ped Emerg Care 2007; 23:262-266.
Sources
For more information on pediatric sedation in the ED, contact:
- Linette Margallo, RN, BScN, Advanced Nursing Practice Educator, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8 Canada. Phone: (416) 813-8645. E-mail: [email protected].
- Michele Morin, RN, MSN, Clinical Nurse Specialist, Emergency Services, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115. Phone: (617) 355-4673. E-mail: [email protected].
- Savithiri Ratnapalan, MBBS, M Ed, MRCP, FRCPC, FAAP, Staff Physician, Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8 Canada. Phone: (416) 813-7532. Fax: (416) 813-5043. E-mail: [email protected].
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