Original article
Preprinted Order Sets as a Safety Intervention in Pediatric Sedation

https://doi.org/10.1016/j.jpeds.2008.12.022Get rights and content

Objectives

Implement preprinted packets for pediatric procedural sedations to increase documentation compliance and decrease medication ordering errors.

Study design

Retrospective chart review of pediatric inpatients undergoing procedural sedation before and after implementation of a preprinted packet including an order set, consent form, and sedation monitoring form. Patient charts before and after the intervention were reviewed for completeness of medical documentation, correct medication dosages, and adverse events. χ2 or Fisher exact test was used to determine preintervention vs postintervention differences.

Results

Forty-two charts preintervention and 42 postintervention were reviewed. Documentation compliance increased on consent forms (P < .001), procedure notes (P = .113), and sedation monitoring forms (P = .003), while dating and timing of order forms decreased. Ordering of resuscitation equipment (P = .12), documentation of American Society of Anesthesiologists' (ASA) physical status classification (P < .001) and allergies (P < .001), and postsedation orders (P < .001) also increased. Medications ordered using unit/kg increased 43% (P < .05). Medication ordering errors for sedation agents decreased 64% (P < .001). Ordering of appropriate reversal agents increased 73% (P = .02).

Conclusions

Implementing preprinted physician orders, consent forms, and prepared packets increased documentation compliance and ordering of reversal agents and resuscitation equipment. Medication dosage ordering errors decreased.

Section snippets

Methods

This project was approved by the Institutional Review Board at Louisiana State University Health Sciences Center-Shreveport. Prior to July 2004, there was no standard order set for pediatric patients requiring procedural sedation in our institution. A standard order set was created by one of the authors (M.B.) with input from the Pediatric Department Chairman and a Pediatric Intensivist (available by request from M.B.). The list of all required documents for pediatric procedural sedations was

Results

A total of 84 charts were reviewed (42 preintervention and 42 postintervention). The mean ages of the patients being sedated were 71 months “before” (range: 19 days to 15 years old) and 43 months “after” (range: 60 days to 14 years old). Sedation was required for a variety of diagnostic and therapeutic procedures in both groups. After the implementation of pre-printed physician orders, consent forms and prepared packets, 2% of order forms (1 of 42) and 14% of consent forms (6 of 42) were still

Discussion

By implementing preprinted physician orders and prepared packets for pediatric procedural sedation, we were able to demonstrate a significant increase in documentation compliance while decreasing medication ordering errors. We reduced medication ordering errors by 64% by simply implementing preprinted order sets for pediatric procedural sedation.

Previous studies using preprinted or formatted order sets have been conducted in different settings including emergency departments and oncology units.

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    The authors have no financial affiliation or conflict of interest in the subject matter, materials, or products mentioned in this manuscript.

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