Did the Introduction of a Sedation Safety Checklist Reduce the Rate of Sedation Adverse Events in a Pediatric Emergency Department?

Background: Adverse events (AEs) related to sedation occur at a low frequency but can be serious. A sedation safety checklist is a set of items which need to be checked before any sedation. We hypothesized that implementation of this checklist would improve compliance with medication regimens and monitoring and reduce the rate of serious AEs in a pediatric Emergency Department.

Methods: A retrospective, before-and-after comparative study was conducted. We evaluated the impact of checklist administration on the rate of serious AEs in all patients sedated with the combination of ketamine and propofol between 2013 and 2019. A serious AE was defined as apnea, laryngospasm, or oxygen desaturation (≤ 90%). Using an intelligence information system, sedation data was extracted from the electronic medical records.

Results: The before-and-after cohorts included 1,349 and 1,846 patients, respectively. The two cohorts were similar regarding medication dosages, type of procedure, length of procedure, and the physician who performed the sedation (resident or attending). A total of 180/1349 (13.3%) and 419/1846 (22.7%) AEs were recorded before and after checklist administration, respectively (p<0.0001). All the AEs were successfully managed and no patient required hospitalization due to an AE. The rates of apnea, laryngospasm and desaturations before and after checklist administration were 48/1349 and 77/1846 (p=0.37), 9/1349 and 30/1846 (p<0.05), and 123/1349 and 312/1846 (p< 0.0001); respectively.

Conclusions: Contrary to the hypothesis, AE rates increased after the introduction of a sedation safety checklist. The findings question the use of a safety checklist before sedation.