Childhood anaphylaxis commonly presents to the ED. More than half of children presenting with anaphylaxis were treated prior to attending the ED. The findings demonstrate that anaphylaxis diagnosis and management guidelines are being adhered to in the majority of cases. There were no adverse outcomes recorded.

Introduction An ongoing comprehensive paediatric procedural sedation (PPS) training and credentialing programme to improve patient safety was introduced into emergency departments (EDs) at a tertiary children's hospital (Royal Children's Hospital; RCH) and a suburban mixed ED (Sunshine Hospital; SH) in Melbourne, Australia. The study aimed to establish whether changes in practice had been sustained 3 years after implementation of the PPS programme. Method 100 PPS episodes were identified at both hospitals (50 at each hospital) pre-implementation, 6 months and 3 years after implementation. This study retrospectively analysed 11 proxy markers of sedation safety by review of prospectively collected sedation records and medical records. Performance during the three time periods was compared using c 2 testing. Results Average age was 6 years and sedations were mainly for fracture reduction and laceration repair. Nitrous oxide and ketamine were the most commonly used agents. Midazolam use decreased over the study period. Six months after implementation at both hospitals relevant proxy markers of sedation safety were significantly improved over the pre-implementation level. Three years after implementation markers of sedation safety were still improved over pre-implementation levels. However, based on a minimum compliance with seven of 11 sedation safety markers both sites deteriorated; RCH from 96% to 80% (p¼0.028) and SH from 68% to 32% (p¼0.001). Conclusion Based on an analysis of proxy markers of sedation safety significant changes over pre-implemenation sedation care were maintained 3 years after implementation of a PPS programme. Documentation of sedation safety markers decreased over the study period, more so at the community hospital. To maintain educational gains and system change in sedation safety requires ongoing resources.Procedural sedation and analgesia for painful and distressing interventions in children has become a standard tool for clinicians in the emergency setting.

In variation to reported practice elsewhere, almost all procedures in this Australian series were undertaken using nitrous oxide and ketamine. The serious adverse events rate was low.