Abstract
Background
Ketamine is a well-studied and safe medication used for procedural sedation in the
pediatric emergency department (ED). However, in our ED and urgent care (UC), we had
higher rates of respiratory events receiving intervention (REs) than has been reported
nationally.
Objective
A quality improvement (QI) project was initiated to address this problem with the
following aim: during a 24-month period, we aimed to decrease REs during i.v. ketamine
sedation from > 10% to < 6% in our network of EDs and UCs.
Methods
Inclusion criteria included patients in our EDs and UCs who received i.v. ketamine
for procedural sedation. We organized a multidisciplinary team to identify key drivers
for the primary outcome (i.e., REs) and establish interventions. We based process
measures on key interventions and utilized 2 Plan-Do-Study-Act (PDSA) cycles, which
we evaluated with Shewhart P (provost) charts. Balancing measures included length of sedation, success of sedation,
and length of stay.
Results
REs decreased from 11.4% to 4.9%; this rate was maintained for 12 months, starting
1 month after PDSA cycle 2 implementation. There was no difference in REs for length
of stay, length of sedation, or success of sedation.
Conclusions
Using QI methodology, we reduced and maintained rates of RE to < 6%. Due to the nature
of the project, it is difficult to link one intervention to the reduction in REs;
however, a significant shift occurred just after PDSA cycle 2 interventions. This
project can give a guideline for interventions to improve the safety of pediatric
ketamine sedations.
Keywords
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Article info
Publication history
Published online: April 10, 2020
Accepted:
March 18,
2020
Received in revised form:
March 5,
2020
Received:
October 7,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
