Pediatric sedation: contributing to evidence-based practice

Who Is Responsible for Measuring Nursing Outcomes?

“…Those two articles varied greatly in scope. Kingston (2000) described the process of identifying and measuring quality indicators for sedation in one pediatric hospital setting, while the second article reported the results of a global study. Using a United Nations data set from 155 countries, Robinson and Wharrad (2000) studied relationships between infant and under-5 mortality rates and the distribution of health professionals, gross national product per capita, and female literacy.…”

Factors Influencing Pediatric Sedation Safety

“…RNs also may monitor sedated patients while an MD administers and supervises administration of the sedative medication, or RNs may administer and monitor approved sedative agents themselves (Barbi et al, 2003;Bates et al, 2005;Hasan, Shayevitz, & Patel, 2003). Sedation practices such as these remain controversial, but little evidence regarding the safety or risk of these RN practices exist (Clark, Flick, & Litman, 2005;Kingston, 2000;Lalwani & Michel, 2005;Mohr et al, 2003;Simmons, 2005;Zeigler & Brown, 1997).…”

“…The type of adverse events that occur when children are sedated by RN providers, and how these differ from the sedation-related adverse events with physicians, is unknown (Beach, Blike, et al, 2005;Beach, Cravero, Blike, Gallagher, et al, 2005). Nursing research addressing outcomes of pediatric sedation have focused on the implementation of different care delivery systems, such as pediatric sedation units, satellite sedation teams, and sedation services provided in the critical care and emergency departments (Bennett, 2003;Catalano, 2002;Dresser & Melnyk, 2003;Kingston, 2000;Lininger, 2004;Smallman, 2003). Published reports of nurses as sedation providers include descriptions of organizational methods of assuring sedation nurse competency, descriptions of nurse-driven sedation protocols including pre-sedation risk assessment, and criteria for referral to higher level providers (Bennett, 2003;Dresser & Melnyk, 2003;Kingston, 2000;Lalwani & Michel, 2005;Lininger, 2004;Pettinicchi, 2005;Zeigler & Brown, 1997).…”

“…Research on sedation-related adverse events in hospitalized children has primarily concerned medication errors. Adverse events in pediatric sedation are reported in the general pediatric, anesthesia, and radiology literature (Coté, Karl, et al, 2000;Coté, Notterman, et al, 2000;Cravero & Blike, 2004;Dresser & Melnyk, 2003;Hoffman et al, 2002;Kingston, 2000;Lowrie et al, 1998;Mace et al, 2004;Malviya et al, 1997). Research supports the opinion that children are at an increased risk of adverse events during sedation, due to factors such as: the limited availability of safe and easily administered sedatives for children; differences in anatomy of the pediatric airway; developmental factors, such as lack of cooperation with procedures; and limited availability of pediatric health care providers (Coté, Karl, et al, 2000;Coté, Notterman, et al, 2000;Cravero & Blike, 2004;Hoffman et al, 2002;Lowrie et al, 1998;Malviya et al, 1997;Polaner et al, 2001).…”