Factors Influencing Pediatric Sedation Safety

Every year, thousands of children require sedation for diagnostic and interventional procedures. Despite regulations by accreditors and guidelines by professional organizations, adverse sedation events and variations in how sedation care is delivered continue to occur. Differences in sedation care may be related to the type of specialist providing sedation, their scope of sedation practice, and methods used to induce sedation. Sedation is performed by a variety of health care providers including registered nurses (RNs), but there are limited data on current regulations governing RN sedation, descriptions of RN sedation practice, or comparisons of outcomes of sedation by different types of providers. This study presents a review of sedation standards shaping RN practice and exemplars of state Boards of Nursing sedation regulations in the United States. The Pediatric Sedation Research Consortium (PSRC) database was used to learn more about RN sedation practices in diagnostic radiology; findings revealed that RNs often plan to achieve deep levels of sedation and administer combinations of two or more sedative medications for diagnostic procedures. Outcomes of sedation for cases where RNs monitored and delivered sedation alone were compared to outcomes of RN and physician teams and physicians working alone to deliver sedation. Cases in which RNs alone provided sedation had similar American Society of Anesthesiologists risk scores compared to cases with physicians alone and RN and physician sedation teams. Findings revealed that cases in which RNs alone or physicians alone monitored and delivered sedation had lower odds of experiencing adverse events than when sedation was administered by RN and physician teams. This study revealed inconsistencies in state Board of Nursing regulations and in RN sedation care standards in the U.S. Data from this study could be used to improve RN sedation care processes, and guide the development of consistent nursing sedation licensing regulations, hospital standards, and policies.