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Pasero Opioid-Induced Sedation Scale in a Pediatric Surgical Ward

A Quality Improvement Project

Garcia, Mayra G., DNP, RN, PCNS-BC; McMullan, Taralyn W., DNP, RN, CNS-BC

Journal of Pediatric Surgical Nursing: April/June 2019 - Volume 8 - Issue 2 - p 29–39
doi: 10.1097/JPS.0000000000000202
Feature Article

Pediatric patients are at risk for adverse events associated with opioid medication. Sedation scales enable nurses to reach knowledgeable decisions maximizing patient safety during opioid administration. Adult literature has focused on the Pasero Opioid-Induced Sedation Scale (POSS) to address this risk in the adult population; however, literature in the pediatric setting is limited.

Purpose The purpose of this quality improvement project was to implement the POSS tool in a pediatric setting and reduce adverse outcomes because of opioid oversedation and respiratory depression.

Methods Two patient cohorts were recruited and evaluated to compare the number of medical emergency team calls, supplemental oxygen use, and length of stay. Bedside nurses received education on opioid-induced sedation and use of the POSS tool. Pretest and posttest surveys were conducted to acquire nurse perceptions of the POSS tool in pediatric postsurgical patients.

Results No medical emergency team calls occurred in the preintervention and postintervention patient cohorts. Eight percent of the preintervention patient cohort required supplemental oxygen in comparison with no oxygen need in the postintervention group. In the postintervention patient cohort, length of stay averages were 185.85 hours (SD = 325.6) in comparison with 89.09 hours (SD = 76.6) in the preintervention group. Nursing survey results improved in nurses' confidence, usage, and assessment using the POSS tool. This project led to widespread use of POSS in the facility.

Conclusions POSS is an appropriate tool to assess pediatric patients in acute care units. The POSS tool assists nurses in accurate assessments and reduces adverse events related to opioid-induced sedation.

Mayra G. Garcia, DNP, RN, PCNS-BC Clinical Nurse Specialist, Children's Health Children's Medical Center, Dallas, TX.

Taralyn W. McMullan, DNP, RN, CNS-BC Associate Professor, University of South Alabama, Mobile, AL.

The authors have declared no conflict of interest.

Correspondence: Mayra G. Garcia, DNP, RN, PCNS-BC, Children's Health Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235. E-mail:

Copyright © 2019 American Pediatric Surgical Nursing Association
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