Pediatrics Resident NewYork-Presbyterian Morgan Stanley Children's Hospital New York, New York, United States
Background: Balancing the appropriate sedation level and comfort of critically ill children in the pediatric intensive care unit (PICU) setting is important for both the safety of patients and the advancement of their medical care (1). The Richmond Agitation-Sedation Scale (RASS) is a reliable tool in the pediatric population for objectively assessing level of sedation (2). In addition, protocolized sedation has previously been shown to decrease opioid exposure days (3). However, whether the increased frequency of RASS scoring can decrease sedation exposure during the peri-extubation period is not known. 1. Egbuta C et al 2021 2. Kerson AG et al 2016 3. Curley MA et al 2015 Objective: To increase frequency of RASS screening, and to compare the peri-extubation sedation exposure before and after the implementation of targeted interventions to increase RASS scoring reporting frequency at a single urban tertiary care children’s hospital. Design/Methods: We implemented QI interventions to increase RASS reporting frequency starting in Sept 2022 throughout our 3 PICUs. Interventions included incorporating RASS scoring into nursing paper reporting sheets, frontline provider plan templates, electronic health record flowsheets, and overall promotion of RASS goal discussion for individual patients. Preliminary analysis of these interventions showed a statistically significant increase in reporting of RASS scores in 1 of 3 PICUs. We plan to conduct a chart review of the 3 months before and after implementing these interventions. All intubated patients with > 5 days of sedation exposure, excluding patients with failed extubation, will be included. Total sedation exposure, including opioid, alpha-2 agonist, and benzodiazepine exposure in the 48 hours before and after extubation will be calculated. Statistical analysis will be performed via T-test analysis of monthly per-patient sedation averages, normalized to weight, and displayed with a double histogram.
Nov – Dec: Review of EMR data and sample set selection. Dec – Feb: Calculation of total sedation exposure Feb– Mar: Statistical analysis.
