Pasero Opioid-Induced Sedation Scale in a Pediatric Surgical Ward: A Quality Improvement Project

Abstract

Pediatric patients are at risk for adverse events associated with opioid medication. Sedation scales enable nurses to reach knowledgeable decisions maximizing patient safety during opioid administration. Adult literature has focused on the Pasero Opioid-Induced Sedation Scale (POSS) to address this risk in the adult population; however, literature in the pediatric setting is limited. Purpose The purpose of this quality improvement project was to implement the POSS tool in a pediatric setting and reduce adverse outcomes because of opioid oversedation and respiratory depression. Methods Two patient cohorts were recruited and evaluated to compare the number of medical emergency team calls, supplemental oxygen use, and length of stay. Bedside nurses received education on opioid-induced sedation and use of the POSS tool. Pretest and posttest surveys were conducted to acquire nurse perceptions of the POSS tool in pediatric postsurgical patients. Results No medical emergency team calls occurred in the preintervention and postintervention patient cohorts. Eight percent of the preintervention patient cohort required supplemental oxygen in comparison with no oxygen need in the postintervention group. In the postintervention patient cohort, length of stay averages were 185.85 hours (SD = 325.6) in comparison with 89.09 hours (SD = 76.6) in the preintervention group. Nursing survey results improved in nurses' confidence, usage, and assessment using the POSS tool. This project led to widespread use of POSS in the facility. Conclusions POSS is an appropriate tool to assess pediatric patients in acute care units. The POSS tool assists nurses in accurate assessments and reduces adverse events related to opioid-induced sedation.

Brazilian version of the Pasero Opioid-Induced Sedation Scale: cross-cultural adaptation study

“…These actions revealed positive aspects: feeling confident about using the instrument correctly (t(5) = −6.325, p 0.001); finding it easier to score pediatric patients (t(5) = −5.000, p .004); and standardization of the safe use of opioids when administered for pain (t(5) = −5.000, p .004). The result was uniform communication about patients' sedation levels in the team, corroborating the findings of this study (13) .…”

Versão brasileira da Pasero Opioid-Induced Sedation Scale: estudo de adaptação transcultural

“…Estudo de coorte prospectivo, com 20 participantes em cada grupo, realizado nos EUA, pesquisou a percepção da enfermagem sobre a ferramenta POSS por meio de um questionário de 10 perguntas, sendo pré-teste (n = 9) e pós-teste (n = 6). Essas intervenções evidenciaram aspectos positivos: confiança ao usar o instrumento corretamente (t(5) = −6,325, p < 0,001; facilidade em pontuar pacientes pediátricos (t(5) = −5.000, p < .004) e padronização do uso seguro de opioides quando administrados para dor (t(5) = −5.000, p < .004), fornecendo comunicação uniforme entre a equipe em relação aos níveis de sedação dos pacientes, corroborando com os achados desse estudo (13) .…”