Adult procedural sedation in the emergency department Bethany Patel, P. Blankenship, R. Lazim, K. Allmond, J. Chapman Blount Memorial Hospital - Maryville, TN
Background/Purpose: Orthopedic injuries often require urgent closed reduction that is typically facilitated with sedative/analgesic agents. No standard exists for the selection of procedural sedation agents at BMH and remains highly physician dependent. A 2017 study suggested that having electronic decision support tools improved dosing of medications during procedural sedation. This study will evaluate primary outcomes associated with creating a CPOE procedural sedation orderset for the emergency department (ED) including incidence of adverse effects, compliance with guideline-dosing, documentation of patient monitoring, and improving patient safety. A secondary outcome will be to ensure adequate charge capture.
Methodology: This is a retrospective, single-center, cohort study. Our pre-intervention group will consist of adult patients greater than 18 years old seen in the ED for closed joint reduction with procedural sedation from July 1, 2017 to July 1, 2018. Information collected included: medication and doses used, patient weight, adverse effects noted, pharmacist presence during procedure, need for supportive care, and patient vital signs. A procedural sedation orderset was developed and approved in fall 2018 and activated in December 2018 after provider education. The post-intervention group will consist of patients seen in ED for closed joint reduction from January 1, 2019 to March 31, 2019 after implementation of the new orderset. Patients will be excluded if the procedure was not completed in the ED. Data from both groups will be compared to look for differences in primary outcomes.
Presentation Objective: Discuss the impact of having a CPOE procedural sedation orderset for the ED of a community hospital.
Self-Assessment: Does having a CPOE orderset for procedural sedation improve medication safety in the ED?
