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Guidelines to Practice: The Process of Planning and Implementing a Pediatric Sedation Program

Ratnapalan, Savithiri MBBS, MEd, MRCP, FRCPC, FAAP; Schneeweiss, Suzan MD, MEd

doi: 10.1097/PEC.0b013e31803f7566
Pediatric Hospitalist

Objective: Pediatric sedation practices vary among institutions and even within the same institution depending on providers and location. We planned to implement a pediatric procedural sedation program for a tertiary care pediatric emergency department to standardize sedation practices among emergency physicians.

Methods: An interactive contextual planning model was adapted, and several tasks were initiated simultaneously. The director of pediatric emergency medicine and clinical director of the institution approved the proposal for the sedation program. Needs assessment surveys and focus group interviews were conducted to identify educational needs of the target audience and infuse a sense of ownership. A grant was obtained from the institution because the budget exceeded available divisional funds. Other pediatric sedation guidelines and published literature were used to produce a sedation handbook and pocket card. Interim approval was obtained from the Drugs and Therapeutics Committee and the Patient Care Committee.

Results: The program was successfully implemented after all physicians and nurses working in the emergency department attended a half-day sedation course and completed a multiple-choice examination. Random chart audits verify that the emergency physicians are performing almost all procedural sedations now as per protocol.

Conclusions: Implementing a structured program facilitates guideline adherence. Adapting a flexible contextual planning model was successful in translating guidelines to practice where resources were limited, and the target audience was highly trained adult learners.

Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

The Pediatric Sedation program was supported by a grant from the Paediatric Consultants, The Hospital for Sick Children, Toronto, Canada.

Address correspondence and reprint requests to Savithiri Ratnapalan, MBBS, MEd, MRCP, FRCPC, FAAP, Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.