Ketamine Sedation and Hypoxia: A Quality Improvement Project to Reduce Respiratory Events Receiving Intervention |
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| Affiliation: | 1. Department of Pediatric Emergency Medicine, Children''s Hospital Colorado, Aurora, Colorado;2. University of Colorado, School of Medicine, Aurora, Colorado;1. Mount Sinai Medical Center, Miami Beach, Florida;2. Florida International University, Miami, Florida;3. Nova Southeastern University, Davie, Florida;1. Department of Emergency Medicine, Skåne University Hospital, Lund, Sweden;2. Department of Cardiology, Skåne University Hospital, Lund, Sweden;3. Department of Clinical Sciences at Lund, Lund University, Lund, Sweden;1. Division of Urology, Duke University Medical Center, Durham, North Carolina;2. Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama;3. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;4. Carter Consulting, Inc., Atlanta, Georgia;5. Division of Pediatric Pulmonary Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia;6. Division of Urology, Primary Children’s Hospital, Salt Lake City, Utah;1. Department of Cardiology, Hunan Provincial People''s Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China;2. Department of Electrocardiography, Hunan Provincial People''s Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China;3. Department of Radiology, Hunan Provincial People''s Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China;1. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas;2. Department of Oncology, Zhong Shan Hospital, Xiamen Medical University, Xiamen, People’s Republic of China;3. Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China;4. Department of Emergency Medicine, King Hussein Cancer Center, Amman, Jordan;5. Department of Intensive Care, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China;7. Center of Diagnosis and Treatment of Cervical Disease, Obstetrics and Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People’s Republic of China;11. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas;12. Department of Laboratory Medicine, Qilu Hospital, Qilu Medical University, Jinan, Shandong, People’s Republic of China;8. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas;10. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas |
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| Abstract: | BackgroundKetamine 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.ObjectiveA 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.MethodsInclusion 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.ResultsREs 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.ConclusionsUsing 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. |
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| Keywords: | pediatrics sedation ketamine quality improvement |
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