Written by Rebecca White
Spoon Feed
Quality improvement interventions including education, order sets, and detailed checklists led to decreased time to post-intubation sedation (PIS) in a pediatric ED.
Sedation without hesitation
Inadequate PIS can lead to unsafe patient care events including unplanned extubations and awake paralysis. In this pediatric ED, data from 2018 to 2020 showed only 25% of intubated patients received PIS in an adequate time frame, and there were 2 unplanned extubations. This single-center study aimed to reduce time to initiation of PIS from 39 minutes to less than 15 minutes.
A multidisciplinary quality improvement team developed a protocol to standardize PIS. Primary measure was time from intubation to administration of first sedation medication. Secondary measure was unplanned extubations. The balancing measure was PIS-related hypotension requiring vasopressors. Plan-do-study-act cycles informed interventions for protocol development, awareness, education, development of order set, and PIS checklist.
The implemented protocol resulted in decreased mean time to PIS from 39 minutes to 21 minutes. With subsequent educational interventions, order set implementation, and the addition of PIS to the intubation checklist at the facility, mean time to PIS decreased to 13 minutes. This continued for 9 months without any observed PIS-related hypotension or unplanned extubations.
How will this change my practice?
PIS can be an afterthought when managing critically ill patients, and this study serves as a reminder of potential adverse effects of delayed sedation. Authors suggest several process improvement strategies that can be implemented in most care environments; I am considering bringing these to my own institution to decrease time to PIS.
Source
Reducing Time to Postintubation Sedation in a Pediatric Emergency Department. Pediatrics. 2024;153(4):e2023062665. doi:10.1542/peds.2023-062665
