Article Text

Download PDFPDF
Adherence to safety guidelines on paediatric procedural sedation: the results of a nationwide survey under general paediatricians in The Netherlands
  1. P L J M Leroy1,
  2. F H M Nieman2,
  3. H E Blokland-Loggers3,
  4. D M Schipper4,
  5. L J I Zimmermann1,
  6. J T A Knape5
  1. 1Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3Dutch Society of Pediatrics, Section General Pediatrics, Utrecht, The Netherlands
  4. 4Dutch Institute for Health Care Improvement CBO, Utrecht, The Netherlands
  5. 5Department of Anesthesiology, University Medical Centre Utrecht, The Netherlands
  1. Correspondence to Piet Leroy, Department of Pediatrics, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands; p.leroy{at}


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

Study design and methods: Sample survey Safety guidelines on PS were split into four domains (“Presedation Assessment”, “Monitoring during PS”, “Recovery after PS” and “Facilities and Competences for Emergencies and Rescue”). Each domain was operationalised into sub-domains 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). An 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 paediatricians, 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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.