Sedation by Trained Non-Physician Practitioners in a Government Hospital in Kenya

Background: In low-resource countries, fracture reduction (FR) is usually performed on awake children without any form of sedation. As part of a quality improvement project (QIP), a sedation service by trained nurses and clinical officers was established in a Kenyan hospital. We aimed to evaluate the safety of sedation performed by non-physicians.

Methods: A group of Israeli practitioners from the Technion University implemented the QIP, which included a 1-day simulation-based sedation training followed by sedation of children together with course instructors. Each sedation was then prospectively recorded using a standardized data-collection-form. We analyzed adverse events and level of satisfaction from the procedure, rated on a 6-point Likert scale.

Results: Seventy-five patients with a mean age of 8.1±3.4 years and a male/female ratio of 61/14, underwent FR under sedation during the first three months of the project. Seventy-one (95.9%) procedures were successfully completed. In the four unsuccessful procedures, no adverse event was recorded. During procedure, 4 (5.3%) patients experienced vomiting and 1 (1.3%) experienced over-salivation. During recovery, 2 (2.6%) patients experienced hypoxia. All the adverse events were successfully managed with suctioning, oxygen supplementation or bag-mask-ventilation. No patient required hospitalization due to an adverse event. The level of satisfaction median score was 6 (interquartile range 5-6).

Conclusions: The results from the first cohort of patients of the QIP suggest that sedation was safely performed by the non-physicians. The level of satisfaction from the procedure was high. The findings suggest that in a low-resource setting, sedation by non-physicians is a feasible option.