| Primary Author: | Joy Hesselgrave, MSN, RN, CPON |
| Co-Principal Investigators/Collaborators: | M. Brooke Bernhardt, Marla Daves, Kala Kamdar, Kathy McCarthy, Marilyn J. Hockenberry |
| Organization: | Texas Children’s Hospital |
Abstract
Background
A review of current clinic procedural sedation practices revealed that dosages for sedation agents were below recommended amounts found in the literature. As part of the Quality Transformation (QT) Core within our Cancer Center, an evidence-based (EB) procedural sedation guideline was developed to improve care for children who experience painful procedures as part of cancer treatment.
Purpose
The goal of this interdisciplinary QT project was to increase the number of patients achieving adequate sedation by implementing the EB guideline for 100% of the patients undergoing clinic procedures under moderate sedation. Key drivers for success included educating and engaging faculty and staff about the EB guideline and sedation order changes.
Methods
QT outcome measures evaluated satisfaction with sedation and a score of the child’s level of sedation as perceived by parents, providers, and nurses. To ensure that the sedation drug dosing was safe, the number of reversal agents used before and after implementation of the EB guideline was monitored. The total time sedated as well as total monitoring time in the clinic was assessed to ensure increased sedation dosing did not negatively impact clinic patient flow.
Results
Quality metrics were evaluated in 35 children over a two-week period and compared with data collected on 30 children prior to implementation of the EB guideline. There was an increase in the target level of sedation (“sleeping comfortably or awake but relaxed and cooperative”) after EB guideline implementation. There was a reduction in patients who were “awake and crying or moving” as reported by respondents. There was no significant increase in the number of reversal agents used, time sedated, or time monitored.
Conclusion
This QT project demonstrates that interdisciplinary collaboration improves EB guideline implementation success and can greatly impact procedure sedation success for children with cancer.
© Improvement Science Research Network, 2011