Final2_ mod sed_survey

Pediatric Moderate Sedation in the ED Survey
Job Title of Survey Respondent(s) Check all that apply Moderate Sedation Definition: A drug-induced
depression of consciousness during which commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function Source: American Society of Anesthesiologists,
Task Force on Sedation and Analgesia by Non- Anesthesiologists.
sedation and analgesia by non-anesthesiologists.
Anesthesiology. 2002;96:1004 –1017.
1. How does your emergency department define the pediatric population? Check one answer only


2. What is the average volume of pediatric (defined as 0 through 15 years old) ED visits per year in your facility? Check one answer only 3. What is the average volume of ALL patient (adult and pediatric) ED visits per year in your 4. Does your hospital have a moderate sedation policy/clinical guideline? o Yes (if yes, answer Q.4 a - c) o No (skip to Q.5) 4a. Does your hospital’s moderate sedation policy/clinical guideline specifically address pediatrics? 4b. Are NPO status guidelines included in your hospital’s moderate sedation policy/clinical guideline? 4c. How recently has your moderate sedation policy/clinical guideline been updated/reviewed? o In the past 6 months o In the past 12 months o Has not been updated/reviewed in the past year 5. Does your hospital require an IV to be started on all pediatric patients undergoing moderate 6. Does your hospital require physicians to undergo a credentialing process before being allowed to administer/perform sedation? o Yes (if yes, answer Q.6a) o No (skip to Q.7) 6a. What is included in your hospital’s sedation credentialing process for physicians? Check all that apply o Minimal # years of experience o Minimal # of supervised procedures o PALS/APLS/NRP training o Pharmacology course o Practical competency test o Recommendation by Anesthesia department o Self-assessment o Self-study o Written competency test o Other ________ o None 7. Does your hospital require other medical staff (e.g., RN, PA, APN) to undergo a sedation competency course/process before being allowed to assist with sedation? o Yes o No 8. Does your hospital have a formal pediatric sedation service/team? 9. Does your hospital conduct moderate sedation chart reviews for QI purposes? o Yes (if yes, answer 9a & b) o No (skip to Q.10) 9a. What indicators are included in chart reviews? Check all that apply QI Indicators
a. Airway assessment/Mallampati Classification e. Immediate prior-to-sedation physical assessment k. Drug calculations/preparation/med worksheet l. Monitoring during/post sedation at appropriate intervals u. Complications (reversal agent given, recovery time > 90 min, unplanned admission, Oxygen desaturation, etc) w. Patient/parent education (explanation of procedure)
x. Patient/parent education (explanation of moderate sedation)
9b. What is done with that information? Check all that apply o Implement staff education o Review at staff meetings o Review at ED QI meetings o Review at hospital-wide QI meetings o Nothing o I Don’t Know o Other _____________________
10. Which of the following services/areas perform pediatric sedation? Check all that apply
o Burn unit o ED o EEG o GI lab o Outpatient center o PACU o Pediatric unit o PICU o Radiology/MRI/CT o Urology o None o Other ______________
11. Does your ED perform moderate sedation to pediatric patients in the ED?
o Yes (if yes, answer 11a)
o No (if no, end survey here)
11a. Does your ED restrict performing moderate sedation on any of the following age groups?
Check all that apply
o Neonate (< month) o Infant o Toddler o Preschool o School age o Preadolescent o Adolescent o No age restrictions If you answered YES to Question #11, please continue to the Sedation Scenario section of this survey. If you answered NO to Question #11, you have completed the survey. Please respond to the questions based on your institution’s common practices,
Case #1

A 3-year-old male is brought in by his mother after he fell playing in the park about 2 hours ago. He
has a 2cm hematoma on the right side of his head.
The mother states he was unresponsive for about 5 minutes and threw up 3 times initially, but has
not thrown up in the last 90 minutes or during the car ride to the ED.
There are no focal findings.

He will require moderate sedation for a CT of the brain.
The child is very anxious and the mother states he will not hold still during the head CT.
Sedation is discussed with the mother and she agrees to this.
His vital signs are: Temp: 37.3/99.1 HR: 114 RR: 22 BP: 98/62 O2 saturation: 99% on RA
Assuming he has no other injuries or contraindications to sedation,
please answer the 8 related questions.
1. What would be included in the pre-sedation assessment of this patient? Check all that apply o Aldrete score o Allergies o Anesthetic plan o ASA classification o Body habitus o Drug calculations/preparation/medication worksheet o Equipment checklist o History of anesthesia o History & Physical o Mallampati classification/Airway assessment o Modified Ramsey score o NPO Status o Pain Score o Physician credential check o Time out/universal precautions o Vital signs o Other ______________ o None 2. For the following items, how long would you routinely wait before sedating this patient? 3. In this scenario, where would you routinely sedate this patient? Check one answer only o In the ED (using a portable CT) o In the ED, then transport to Radiology o In Radiology o Other ___________________ 3a. Based on where this patient would be sedated, what monitoring equipment, supplies & medications would be required at the bedside (or taken with you during transport)? Check all that apply 4. In this scenario, is the person responsible for monitoring the sedated patient allowed to perform or assist with the procedure?
5. Which of the following medication(s) would you typically use to moderately sedate this patient?
Check all that apply
o Ativan (Lorazepam) o Brevital (Methohexital) o Chloral Hydrate o Clonidine o Demerol (Meperidine) o Diprivan (Propofol) o Droperidol o Etomidate o Fentanyl o Haldol o Ketamine o Morphine o Nembutal (Pentobarbital) o Nitrous Oxide o Phenergan (Promethazine) o Precedex (Dexmedetomidine) o Thorazine (Chlorpromazine) o Valium (Diazepam) o Versed (Midazolam) o Other: ______________
6. DURING the CT, what monitoring/charting would be required? Check all that apply

o Head position check/re-check o Heart rate o Respiratory rate o Oxygen saturation o Blood pressure o Temperature o Skin color o Capnography o Level of Consciousness (LOC) o Modified Ramsey score o Protective reflexes o Aldrete score o I&O o Pain score o Med dosage/route o Other ______________ o None
7. DURING the CT, how often would patient assessment be performed? Check one answer only

o Continuously o Every 5 minutes o Every 15 minutes o Every 30 minutes o Not standardized o Other ______________ 8. What discharge criteria would this patient need to meet before disposition? Check all that apply o Returned to pre-sedation mental status (e.g., able to talk if age appropriate) o Returned to pre-sedation activity level (e.g., awake, able to sit up unaided if age- o After a specified length of stay o Able to take fluids o Stable vital signs o Oxygen saturation > 95% on room air or at patient’s baseline o Cardiovascular function and airway patency are satisfactory and stable o Easily arousable o Pain adequately controlled o Physician discretion o After a specified length of stay when a reversal agent was given o Able to be discharged to responsible adult and/or second adult to monitor child on trip o Patient/parent discharge instructions given o Patient is provided a 24-hour emergency telephone contact o Other __________________ o None
Case #2
A six-year-old female has suffered a severely angulated wrist fracture in a fall.
The child is very agitated and cries when any stranger comes near her.
The orthopedist will perform a fracture reduction, and the child will need moderate sedation to
undergo the procedure.
Her vital signs are: Temp: 36.4/97.5 HR: 110 RR: 28 BP: 108/70 O2 saturation: 99% on RA
Assuming no other injuries or contraindications to sedation,
please answer the 7 related questions.
1. What would be included in the pre-sedation assessment of this patient? Check all that apply o Aldrete score o Allergies o Anesthetic plan o ASA classification o Body habitus o Drug calculations/preparation/med worksheet o Equipment checklist o History of anesthesia o History & Physical o Mallampati classification/Airway assessment o Modified Ramsey score o NPO Status o Pain Score o Physician credential check o Time out/universal precautions o Vital signs o Other ______________ o None 2. What monitoring equipment, supplies & medication would be required at the bedside for this patient? Check all that apply 3. In this scenario, is the person responsible for monitoring the sedated patient allowed to perform or assist with the procedure?
4. Which of the following medication(s) would you typically use to moderately sedate this patient?
Check all that apply
o Ativan (Lorazepam) o Brevital (Methohexital) o Chloral Hydrate o Clonidine o Demerol (Meperidine) o Diprivan (Propofol) o Droperidol o Etomidate o Fentanyl o Haldol o Ketamine o Morphine o Nembutal (Pentobarbital) o Nitrous Oxide o Phenergan (Promethazine) o Precedex (Dexmedetomidine) o Thorazine (Chlorpromazine) o Valium (Diazepam) o Versed (Midazolam) o Other: ______________
5. DURING the procedure, what monitoring/charting would be required? Check all that apply

o Head position check/re-check o Heart rate o Respiratory rate o Oxygen saturation o Blood pressure o Temperature o Skin color o Capnography o Level of Consciousness (LOC) o Modified Ramsey score o Protective reflexes o Aldrete score o I&O o Pain score o Med dosage/route o Other ______________ o None 6. DURING the procedure, how often would patient assessment be performed?
Check one answer only

o Continuously o Every 5 minutes o Every 15 minutes o Every 30 minutes o Not standardized o Other ______________ 7. What discharge criteria would this patient need to meet before disposition? Check all that apply o Returned to pre-sedation mental status (e.g., able to talk if age appropriate) o Returned to pre-sedation activity level (e.g., awake, able to sit up unaided if age- o After a specified length of stay o Able to take fluids o Stable vital signs o Oxygen saturation > 95% on room air or at patient’s baseline o Cardiovascular function and airway patency are satisfactory and stable o Easily arousable o Pain adequately controlled o Physician discretion o After a specified length of stay when a reversal agent was given o Able to be discharged to responsible adult and/or second adult to monitor child on trip o Patient/parent discharge instructions given o Patient is provided a 24-hour emergency telephone contact o Other __________________ o None Thank you for your participation!!

Source: http://www.luhs.org/depts/emsc/ModSedSurveyForm.pdf