Among the many benefits of the SPS, I find that the different perspectives, experiences, knowledge and insights that are shared by its members are among the most valuable to me. These perspectives come from the various professional, educational and geographic differences we share within our common interest in providing high quality and safe pediatric sedation. As the pandemic continues to interrupt our professional and social lives for the foreseeable future, it has increased my recognition and appreciation for these collegial relationships and interest in how these influence sedation practice.
In this issue of the SPS Newsletter, I will highlight a small sample of articles, many from our members; that demonstrate how our different perspectives advance pediatric sedation care through our diverse professional research lenses.
Trends in Outpatient Procedural Sedation: 2007-20181
In this study using Pediatric Sedation Research Consortium (PSRC) data, the investigators analyzed 432,842 sedation encounters categorizing them into 3 epochs (2007-2011, 2011-2014 and 2014- 2018).1 Major findings include increases in hospitalists providing procedural sedation and the use of Dexmedetomidine for sedation but no significant increases in overall serious adverse events.1 Other findings include a reduction in infants < 3 months of age receiving procedural sedation, reduction in the use of chloral hydrate and pentobarbital, fewer sedations by radiologists, nurse anesthetists, advanced practice nurses or physician’s assistants, nurses, surgeons and general pediatricians. This study provides a broad overview of the evolving practice of pediatric sedation care; however there are persistent variations in sedation care models that exist regionally that are also important to understand.
A Pediatric Nurse Practitioner-Led Moderate Sedation Service: Our 7-Year Experience2
Although, some sedation programs include nurse practitioner (NP) delivered sedation, little is known about this sedation delivery model. This study is the first published report of an NP-led pediatric sedation service. The author provides an excellent description of the history of the program, the institutional support, training, forms used and the evolving role of the sedation NP.2 This study used retrospective quality improvement metrics to describe the 3,151 patients referred to the NP sedation service of which 2,293 (72.7%) received sedation. Patient, procedural, referral characteristics and adverse events were provided for the sample at their institution. There were no major adverse events and few (n=37) minor adverse events such as apnea, desaturation, delirium and failure to sedate. The study emphasized that the combination of pediatric NPs overseen by anesthesia, institutional support and a strong pediatric nursing team are the keys to implementing this care model. In describing the procedures for sedation preparation, the author explains that child life specialists are available for consultation but there is no dedicated child life specialist assigned to the team. There is limited research on the impact that child life specialists have on sedation care or on child-life and nurse teams working in the pediatric setting.
Exploring distraction and the impact of a child life specialist: Perceptions from nurses in a pediatric setting3
Child life specialists are recognized as experts in providing interventions that reduce the stress and anxieties associated with pediatric hospitalization and procedures. However, nurses also often use distraction techniques to assist children and their caregivers coping with diagnostic and painful procedures. However, in prior studies, nurses identified struggling to deliver adequate support, such as distraction during procedures due to work constraints and the need to focus on assisting physicians during procedures. This study, explores nurse perceptions of the use of distraction and the role of child life specialists caring for children during painful procedures. The authors used a qualitative focus group design and thematic analysis to identify five themes. Results of this study include that nurses viewed child life specialists as integral to their practice and viewed them as positive influences for children and families, while viewing themselves as “mean” and “unkind” because of the nature of their work and providing simplistic interventions compared to the child life specialist.3 Thus, the presence of the child life specialist was reassuring to both the child and the nurse during procedures.
As these three examples demonstrate, each of our respective education and training provides unique opportunities to improve sedation care through research. Future research endeavors that promote interdisciplinary sedation teams in the development of research questions, design, methods and analysis of data could provide data needed to develop improved sedation delivery models, education and safety.
- Kamat PP, McCracken CE, Simon HK, Stormorken, A., Mallory, M., Chumpitazi, C.E., Cravero, J.P. Trends in Outpatient Procedural Sedation: 2007-2018. Pediatrics. 2020;145(5):e20193559. doi:10.1542/peds.2019-3559
- Dorr, P. A Pediatric Nurse Practitioner-Led Moderate Sedation Service: Our 7- Year Experience. The Journal for Nurse Practitioners. 2020: 16(5), 366-370. https://doi.org/10.1016/j.nurpra.2020.02.014
- Drayton, N.A., Waddups, S., Walker, T. Exploring distraction and the impact of a child life specialist: Perceptions from nurses in a pediatric setting. J Spec Pediatr Nurs. 2019; 24:e12242. https://doi.org/10.1111/jspn.12242