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315 IMPROVEMENT IN DOCUMENTATION AND DRUG DOSING AFTER IMPLEMENTATION OF A STANDARD ORDER SET FOR PEDIATRIC SEDATION.
  1. M. Broussard1,
  2. P. F. Bass1,
  3. C. A. Arnold1
  1. 1Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA

Abstract

Background Medical errors are common in hospitals. Pediatric sedation requires many dosage calculations and a plethora of available equipment. Thus, there are many possible medical errors.

Purpose The purpose of this study was to determine if preprinted forms and prepared packets for pediatric sedations at our institution would improve documentation compliance, reduce medication ordering errors, and thus reduce the number of adverse events during pediatric sedations.

Methods Our pilot study includes 42 sedations before the intervention and 26 after the intervention. Charts were reviewed for correct dosage of medicine and completeness of medical documentation.

Results The mean ages of the patients being sedated were 71 months in the “before” group and 45 months in the “after” group. After the implementation of preprinted physician orders, consent forms, and prepared packets, 4% of order forms and 11% of consent forms were still handwritten. One hundred percent documentation compliance on consent forms increased from 32% before to 69% after. Dating and timing of order forms decreased (98 to 73%; 81 to 65%), and ordering of resuscitation equipment, ASA class, listing of allergies, and postsedation orders increased (93 to 100%; 0 to 81%; 64 to 100%; 43 to 100%). Our procedure notes (PNs) and sedation monitoring forms (SMFs) were not changed in the process; documentation compliance increased 90 to 96% (PNs) and 81 to 100% (SMFs). Medications were ordered using mg/kg or mcg/kg in 56% of the handwritten order forms as compared to 100% on the preprinted order forms. Medication dosages for Versed, fentanyl for 12 years and younger, fentanyl for greater than 12 years, and ketamine that fell within the recommended dosage range using the Lexis-Comp's Pediatric Dosage Handbook, 12th edition (± 10%) before using preprinted orders were 68%, 100%, 71%, and 67% compared with 100%, 95%, 100%, and 100% after implementation. Reversal agents were ordered using mg/kg in 56% before and 100% after. Handwritten orders did not have adequate reversals at all in 8% of patients. There were not enough adverse events in either group to show a difference between the two groups.

Conclusions Using preprinted physician orders, consent forms, and prepared packets increased our documentation compliance in pediatric patients being sedated by the inpatient service. Medication dosage errors were decreased and ordering of reversals and resuscitation equipment increased by using the preprinted documentation packets.

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