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Effect on Hospital-Wide Sedation Practices After Implementation of the 2001 JCAHO Procedural Sedation and Analgesia Guidelines
Raymond Pitetti, MD, MPH;
Peter J. Davis, MD;
Robert Redlinger, RN, MSN;
Jean White, RN;
Eugene Wiener, MD;
Karen H. Calhoun, BSN, MBA
Arch Pediatr Adolesc Med. 2006;160:211-216.
Objective To describe the effect of implementing the Joint Commission on Accreditation of Healthcare Organization’s guidelines for procedural sedation and analgesia (PSA) on the frequency of adverse events occurring during sedation.
Design Prospective, descriptive study.
Setting Urban, tertiary care children's hospital.
Participants Patients requiring PSA.
Interventions A PSA committee and a standardized protocol for PSA were developed during a 6-month period. Institutional oversight was initiated to monitor practitioner compliance with the program. Data were abstracted from the sedation record.
Main Outcome Measures The change in incidence of adverse events during PSA during the study. The strength of the association was determined by computing the Pearson product moment correlation.
Results A total of 14 386 patients received PSA between July 1, 2001, and June 30, 2004. During the study, 7.6% of patients had an adverse event, with the most common being hypoxemia (39.7% of all adverse events). A trend toward a decrease in the incidence of adverse events was found during the study (Pearson product moment correlation, –0.68; P<.001).
Conclusions Implementation of the 2001 Joint Commission on Accreditation of Healthcare Organizations guidelines for the provision of PSA appeared to lead to a decrease in the incidence of adverse events during the study. Implementation of uniform standards of monitoring and care for the provision of PSA may lead to safer conditions for pediatric patients undergoing PSA.
Author Affiliations: Division of Pediatric Emergency Medicine, Departments of Pediatrics (Drs Pitetti and Davis), Anesthesiology (Dr Davis), Perioperative Services (Mr Redlinger), Quality Management (Ms White), Surgery (Dr Wiener), and Quality and Outcomes (Ms Calhoun), Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
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