Pediatric Sedation: Building Bridges to Meet the Need for Quality Care
Pediatric sedation one of the highest risk procedures in the hospital setting. However, the procedure is an infrequent occurrence and is at risk for error. Staff voiced a low comfort level with sedation due to a lack of education, documentation training, and experience.
Relevance/Significance:
The conference goal of: Translate continual practice improvements into viable solutions that advance professional practice or clinical care drove our the thought process behind this project. Our journey began with developing an A3 to see where the current defecits were in the current process. The sedation A3 team consisted of nurses, providers and respiratory therepists. This multidiscipinary team drove the process changes and improvements to improve and will continue to drive future changes.
Strategy and Implementation:
In order to address the staff concerns a three part interdisciplinary sedation educational bundle was designed to include: documentation training, didactic education and simulation. The bundle was focused on quality, safety and teamwork. Simulation teams consisted of nurses, respiratory therapists and physicians working together through two high fidelity sedation scenarios, including adverse events, interventions and debriefs. Each RN and RT completed a pre-test and pre-evaluation to compile their current knowledge base and comfort level with sedation procedures. After completion of the training, each individual completed a post-test and course evaluation. A follow up post-test and evaluation was also completed at three and six months to gauage retention and need for further training. Over a four day initial training period, 97 team members, including RNs, RTs, and MDs, completed the bundle.
Evaluation:
The average score on the pre-evaluation for level of confidence with current sedation skills was 3 out of 5, with 5 being completely confident. On average, the team members had participated in 4 sedation procedures in the last 12 months and only 7% of the team members had used simulation before for sedation training. Post-Test scores improved substantially, with an average improvement of 15%.
Implications for Practice:
An educational bundle, featuring a combination of documentation, didactic, and simulation opportunities, provides the necessary instruction for sedation training. The addition of interdisciplinary simulation provides opportunity to practice acquired skills in a team setting.