Adherence to safety guidelines on pediatric procedural sedation: the results of a nationwide survey under general pediatricians in The Netherlands

Piet Leroy^1,*, Fred Nieman², Heleen Blokland-Loggers³, Daphne Schipper⁴, Luc Zimmermann¹, Hans Knape⁵

¹ Department of Pediatrics, Maastricht University Medical Centre, Netherlands;
² Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical, Netherlands;
³ Dutch Society of Pediatrics, Section General Pediatrics, Netherlands;
⁴ Dutch Institute for Health Care Improvement CBO, Netherlands;
⁵ Department of Anesthesiology, University Medical Centre Utrecht, Netherlands

Correspondence to: Piet Leroy, paediatrics, Maastricht University Medical Centre, P. Debeyelaan 25, PB 5800, Maastricht, 6202 AZ, Netherlands; p.leroy{at}mumc.nl

Accepted 4 September 2009

Objectives: Following two fatal accidents during pediatric procedural sedation (PS), we investigated the level of adherence to established safety standards on PS in a nationwide cohort of fully trained general pediatricians, entrusted with PS.

Study design and methods: Sample survey. Safety guidelines on PS were split into 4 domains (‘Presedation Assessment’, ‘Monitoring during PS’, ‘Recovery after PS’ and ‘Facilities and Competences for Emergencies and Rescue’). Each domain was operationalized into subdomains and items. Items were presented within a questionnaire list as procedural points of attention on which respondents could give their personal adherence score. Percentages of full adherence were calculated. Non-adherence was defined as gradual deviation from full adherence. After factor and reliability analysis, observed scores were summed up to scales and results were transformed to a 0-10 report mark (RM). A RM of 9 is considered as a satisfactory level of adherence while an RM < 6 is considered as unacceptably low.

Results: Full adherence was rare. For most (sub)domains only a minority of respondents achieved a satisfactory level of adherence. Large numbers of respondents had scores below 6.

Conclusions: Potentially unsafe PS practices are common under Dutch general pediatricians, despite the availability of guidelines. The design of guidelines should include a goal-directed plan for implementation including training, initiatives for continuous quality assurance and improvement and repeated measurements of adherence to guidelines.

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