Professionals' Perception of a Strategy to Avoid Interruptions During Medication Handling.

INTRODUCTION: The use of vests for handling medication (prescription, preparation, and dispensing) in the emergency department is a strategy designed to increase patient safety by reducing interruptions and, consequently, medication errors. In this study, we aim to assess how professionals perceive the use of vests in a pediatric emergency department of a tertiary hospital. MATERIAL AND METHODS: A cross-sectional survey was conducted among pediatric emergency physicians and nurses in October and November 2019. We analyzed the results of a 19-item survey on the perception of vests as a tool for reducing interruptions and medication errors. RESULTS: In this study, 91 surveys were delivered and 89 (97.8%) were completed. One hundred percent of the professionals were aware of the vests. Nurses reported the following reasons for not using the vest: high workload (25%) and preparation of nebulized and oral medications (25%). One hundred percent of doctors asked for the vest because of forgetfulness. Thirty-five physicians (81.4%) and 17 nurses (85.0%) said that wearing the vest, they were rarely or never interrupted. Eighty-two respondents (93.2%) agreed that vests are an effective strategy for minimizing medication errors. CONCLUSIONS: Although medical professionals consider vests to be a useful strategy to prevent interruptions and reduce medication errors, adherence to the protocol is low, so a promotion strategy is needed to encourage professionals to use the vests.

Involving the Patient and Family in the Transfer of Information at Shift Change in a Pediatric Emergency Department.

BACKGROUND: The transfer of information at the change of shift is a critical point for patient experience during the care process. The aim of this study was to evaluate caregivers' perceptions before and after the implementation of a multidisciplinary bedside handoff in a pediatric emergency department (PED). METHODS: This was a quality improvement pre-post intervention, single-center study. The authors included caregivers of patients allocated in the observation unit of a PED during health care provider shift change. The study was made up of the following phases: (1) preintervention survey distribution, (2) implementation of the bedside handoff, involving all health care professionals (including nurses, nursing assistants, and pediatricians) and caregivers, and (3) postintervention survey distribution. The survey explored the three dimensions of patient experience defined as main study outcomes: information received and communication with professionals, participation, and continuity of care. RESULTS: A total of 102 surveys were collected (51 each in the preintervention and postintervention phases). In the preintervention phase, 94.1% of caregivers would have wished to be actively involved in the change of shift. In the postintervention phase, more caregivers felt that professionals had proper introductions (49.0% vs. 84.3%; p < 0.01), had kept them informed of the plan to be followed (58.8% vs. 84.3%; p = 0.02), and encouraged questions (45.1% vs. 82.4%; p < 0.01). Caregivers of the postintervention phase perceived less disorganization during the change of shift (25.5% vs. 5.9%; p = 0.01) and a greater sense of continuity (64.7% vs. 86.3%; p = 0.02). CONCLUSION: The bedside handoff is a useful strategy to improve patient and family perceptions of communication with professionals, information received, and continuity of care at health care providers shift change. Future lines of research and improvement include ensuring equity in participation in the bedside handoff for all caregivers, monitoring the handoffs to determine how often patients/caregivers participate and correct mistakes in information transfer. and exploring professionals' perceptions.

Impacto del mapa de riesgos como estrategia de monitorización y mejora de seguridad del paciente en urgencias / Impact of risk mapping as a strategy for monitoring and improving patient safety in paediatric emergency care

Objetivo: Diseñar un Mapa de Riesgos (MR) como herramienta para identificar y gestionar los riesgos en Urgencias Pediátricas y analizar el impacto de las acciones de mejora desarrolladas a partir de los riesgos identificados, en el nivel de riesgo para la Seguridad del Paciente (SP).Metodología: Un grupo de trabajo multidisciplinar revisó todo el proceso asistencial aplicando la herramienta Análisis Modal Fallos y Efectos (AMFE). Fases del proyecto: 1ª) MR 2017 y planificación acciones de mejora. 2ª) Desarrollo e implantación de acciones de mejora. 3ª) MR 2019. 4ª) Análisis: evolución del MR e impacto de las acciones de mejora. Resultados: En el MR 2017 se identificaron 106 modos de fallo (MF) (54,7% riesgo alto o muy alto). Se aplicaron criterios de priorización para seleccionar las acciones de mejora que debían planificarse. Se planificaron 19 acciones de mejora, con responsables y plazos, que permitían abordar 46 MF prioritarios. Se implantaron el 100%. En el MR 2019 se identificaron 110 MF (48,2% riesgo alto) y se objetivó una reducción global del nivel de riesgo del 20%. Analizando los 46 MF prioritarios que se habían abordado mediante las 19 acciones de mejora planificadas, se comprobó que el 60% habían pasado de nivel de riesgo alto a medio y que se había reducido el nivel de riesgo tanto a nivel global (-27,8%) como desglosado por procesos. Conclusión: El AMFE es una herramienta útil para identificar riesgos, analizar el impacto de las estrategias de mejora y monitorizar el nivel de riesgo de un servicio clínico complejo. Las acciones de mejora desarrolladas han logrado reducir el nivel de riesgo de nuestros procesos, mejorando la SP. (AU)

Objective: To design a risk map (RM) as a tool for identifying and managing risks in the paediatric emergency department and to assess the impact of the improvement actions developed based on the identified risks in terms of the level of risk to patient safety. Methodology: A multidisciplinary working group reviewed the entire care process by applying the Failure Mode and Effects Analysis (FMEA) tool. Project phases: 1) RM 2017 and planning of improvement actions; 2) Development and implementation of improvement actions; 3) RM 2019; 4) Analysis: evolution of the RM and impact of improvement actions. Results: A total of 106 failure modes (FMs) were identified in the 2017 RM (54.7% high- or very high risk). We applied prioritization criteria to select the improvement actions to plan. Nineteen improvement actions were planned, with assigned responsible parties and deadlines, to address 46 priority FMs. One hundred percent were implemented. In the 2019 RM, we identified 110 FMs (48.2% high risk) and found an overall reduction of the risk level of 20%. Analysing the 46 priority FMs that had been addressed by the 19 planned improvement actions, we found that 60% had changed from high to medium risk level and that the risk level had decreased, both overall (–27.8%) and by process. Conclusión: The FMEA is a useful tool to identify risks, analyse the impact of improvement strategies and monitor the risk level of a complex clinical care department. The improvement actions developed succeeded in reducing the level of risk in the processes in our unit, improving patient safety. (AU)

Impact of risk mapping as a strategy for monitoring and improving patient safety in paediatric emergency care.

OBJECTIVE: To design a risk map (RM) as a tool for identifying and managing risks in the paediatric emergency department and to assess the impact of the improvement actions developed based on the identified risks in terms of the level of risk to patient safety. METHODOLOGY: A multidisciplinary working group reviewed the entire care process by applying the Failure Mode and Effects Analysis (FMEA) tool. Project phases: (1) RM 2017 and planning of improvement actions; (2) Development and implementation of improvement actions; (3) RM 2019; (4) Analysis: evolution of the RM and impact of improvement actions. RESULTS: A total of 106 failure modes (FMs) were identified in the 2017 RM (54.7% high- or very high risk). We applied prioritization criteria to select the improvement actions to plan. Nineteen improvement actions were planned, with assigned responsible parties and deadlines, to address 46 priority FMs. One hundred percent were implemented. In the 2019 RM, we identified 110 FMs (48.2% high risk) and found an overall reduction of the risk level of 20%. Analysing the 46 priority FMs that had been addressed by the 19 planned improvement actions, we found that 60% had changed from high to medium risk level and that the risk level had decreased, both overall (-27.8%) and by process. CONCLUSION: The FMEA is a useful tool to identify risks, analyse the impact of improvement strategies and monitor the risk level of a complex clinical care department. The improvement actions developed succeeded in reducing the level of risk in the processes in our unit, improving patient safety.

Risk Factors of Serious Bacterial Infection in Previously Healthy Children Older Than 90 Days Old With Fever and Neutropenia.

BACKGROUND: The main objective was to determine the clinical or analytical factors that independently predict risk of serious bacterial infection (RSBI) in immunocompetent patients older than 90 days given a diagnosis of fever and for whom neutropenia was an incidental finding. The secondary objective was to describe the prevalence of serious bacterial infections (SBIs). METHODS: This is a 3-year-long, multicenter, prospective analytical and observational study carried out at 6 pediatric emergency departments. Data for epidemiological, clinical, and analytical variables were collected. RESULTS: One hundred forty patients with febrile neutropenia (60.7% mild, 39.3% moderate to severe) were recruited. Serious bacterial infection incidence was 15.0% (95% confidence interval [CI], 9-21): 1 Invasive Bacterial Infection (Staphylococcus epidermidis bacteremia), 10 urinary tract infections, 8 pneumonias, and 2 cellulitis. Median total neutrophil counts per microliter showed no statistically significant differences (P = 0.512; 1000 [750-1200] in SBI patients vs 1100 [800-1300] in non-SBI patients). Higher RSBI was observed in patients with neutrophils less than 20% relative to total leukocytes (SBI, 15, 26.3%) than in those with neutrophils of 20% or greater (SBI, 6, 7.2%) (odds ratio, 4.6; 95% CI, 1.7-12.7). In patients with greater than 5000 leukocytes/µL, a percentage of neutrophils less than 20% was related to a greater RSBI with a trend toward statistical significance (odds ratio, 6.1; 95% CI, 0.7-51.1; P = 0.066). The clinical variables did not show a significant association with RSBI. CONCLUSIONS: None of the clinical or analytical variables assessed were associated with the RSBI. However, according to a post hoc analysis, in patients with greater than 5000 leukocytes/µL, a neutrophil percentage less than 20% could be an independent risk factor for SBI. A thorough physical examination and basic diagnostic tests (urinalysis and chest x-ray) may help to establish a diagnosis of SBI in the vast majority of cases.

Documento de recomendaciones sobre la rehidratación intravenosa rápida en gastroenteritis aguda / Recommendation document on rapid intravenous rehydration in acute gastroenteritis

Introducción: Existe consenso en cuanto a la eficacia y seguridad de las pautas de rehidratación intravenosa rápida (RIR) en niños con deshidratación secundaria a gastroenteritis aguda (GEA), pero también una gran variabilidad en su uso en la práctica clínica. Objetivo: Elaborar un documento de recomendaciones sobre la RIR en población pediátrica basadas en la evidencia científica. Metodología: Se diseñó un proyecto basado en metodología GRADE, siguiendo el siguiente esquema de trabajo: formación del grupo de trabajo; formulación de preguntas de investigación y definición de «desenlaces de interés»; puntuación y selección de ítems; revisión bibliográfica; evaluación y síntesis de la evidencia (GRADE); revisión, discusión y formulación de recomendaciones. Se incluyeron 10 preguntas clínicas y 15 desenlaces de interés (siete de eficacia y ocho de seguridad). Resultados: Se establecieron 16 recomendaciones, destacando como principales: 1) la RIR es segura en niños con deshidratación leve-moderada secundaria a GEA, salvo contraindicación expresa o comorbilidad aguda grave (recomendación fuerte, evidencia moderada); 2) se recomienda su uso en este contexto cuando la rehidratación oral haya fracasado o esté contraindicada (fuerte, alta); 3) se recomienda utilizar sueros isotónicos (fuerte, alta), sugiriendo como primera opción el suero fisiológico (débil, baja), añadiendo glucosa (2,5%) en pacientes con glucemia normal y cetosis (fuerte, moderada); 4) se recomienda un ritmo de infusión de 20 mL/kg/hora (fuerte, alta), durante una a cuatro horas (fuerte, moderada). Conclusiones: En este documento se establecen recomendaciones de consenso, basadas en la evidencia científica disponible, que podrían contribuir a homogeneizar el uso de la RIR en nuestro medio. (AU)

Introduction: The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. Objective: To prepare a document with evidence-based recommendations about RIR in paediatric population. Methods: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes»; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). Results: Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1–4 h (strong and moderate). Conclusions: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting. (AU)

Recommendation document on rapid intravenous rehydration in acute gastroenteritis.

INTRODUCTION: The efficacy and safety of the Rapid Intravenous Rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE: To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of "relevant outcomes"; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS: 16 recommendations were set up, from which we can highlight as the main ones: 1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation, moderate evidence). 2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong, high). 3) Isotonic fluids are recommended (strong, high), suggesting saline fluid as the first option (light, low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong, moderate). 4) A rhythm of 20cc/kg/h is recommended (strong, high) during 1-4 h (strong, moderate). CONCLUSIONS: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.

Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge.

INTRODUCTION: In January 2019, the Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. MATERIAL AND METHODS: An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. RESULTS: 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (κ = 0.308; κ = 0.000; κ = 0.586). CONCLUSIONS: The adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2 documents that should be analyzed and corrected according to the available scientific evidence.

Adecuación de la prescripción de antimicrobianos en procesos ambulatorios atendidos en Urgencias / Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge

Introducción: En enero del 2019 la Consejería de Sanidad de la Comunidad de Madrid publicó una guía acerca del uso de antimicrobianos en niños con tratamiento ambulatorio. El objetivo de este trabajo fue estimar la adecuación de la prescripción de antimicrobianos al alta desde el Servicio de Urgencias Pediátricas (SUP) en pacientes con enfermedades infecciosas, tomando como referencia esta guía regional. Secundariamente, se estudió la variación en la adecuación según el diagnóstico realizado y el facultativo prescriptor, y se valoró la concordancia entre dicha guía y los protocolos del centro. Material y métodos:Estudio observacional, descriptivo y retrospectivo en el que se incluyó a pacientes de 0-16 años con diagnóstico al alta del SUP incluido en la guía regional, entre marzo del 2018 y febrero del 2019. La prescripción se consideró adecuada cuando lo era la indicación, y en su caso, el fármaco elegido, la posología (dosis, intervalo y duración) y la vía de administración. Resultados: Se obtuvo una muestra de la que se analizaron 648 procesos infecciosos, siendo tratados con antimicrobianos 165 (25,5%). En 23 procesos no pudo evaluarse la adecuación a la guía por ausencia de algún dato posológico de la prescripción de antimicrobiano. El manejo terapéutico fue adecuado globalmente en 550/625 procesos (88,0%). En los procesos tratados con antimicrobiano, la adecuación fue de 70/142 (49,3%), sin encontrarse diferencias estadísticamente significativas entre facultativo prescriptor. El motivo de inadecuación más frecuente fue el error posológico (26,3%). Infección urinaria, conjuntivitis y otitis media aguda fueron las entidades clínicas con peor adherencia (el 44,4, el 50,0 y el 52,2% respectivamente) y en las que existió una mayor discrepancia entre guía y protocolos (κ=0,308; κ=0,000; κ=0,586). (AU)

Introduction: In January 2019, Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. Material and methods: An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. Results: 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (k=0.308; k=0.000; k=0.586). (AU)

[Recommendation document on rapid intravenous rehydration in acute gastroenteritis]. / Documento de recomendaciones sobre la rehidratación intravenosa rápida en gastroenteritis aguda.

INTRODUCTION: The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE: To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes¼; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS: Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1-4 h (strong and moderate). CONCLUSIONS: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.

[Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge]. / Adecuación de la prescripción de antimicrobianos en procesos ambulatorios atendidos en Urgencias.

INTRODUCTION: In January 2019, Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. MATERIAL AND METHODS: An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. RESULTS: 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (k=0.308; k=0.000; k=0.586). CONCLUSIONS: The adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2documents that should be analyzed and corrected according to the available scientific evidence.

Briefings: A Tool to Improve Safety Culture in a Pediatric Emergency Room.

BACKGROUND: Safety briefings are short, informative meetings intended to integrate a culture of patient safety into daily clinical practice, which contributes to identifying risks and improving quality. The objective of this study is to present safety briefings as a method for discovering and addressing safety events in a pediatric emergency room, describe how professionals perceive them, and characterize the classification and evolution of the incidents identified. METHODS: This observational, descriptive, analytical study was performed in the pediatric emergency department of a tertiary hospital in 2018-2019. The incidents reported during the briefings were counted, classified, and analyzed. Results of a 10-item survey on the usefulness of the briefings in identifying and managing risks are described. RESULTS: A total of 498 briefings were analyzed, in which 1,180 incidents were reported (1 incident/96 emergency cases; 2.4 incidents/meeting). The category with the most incidents was Communication. The number of incidents fell by 24.4% between 2018 and 2019 (p < 0.01), mostly in the Identification (47.8%) and Communication (33.8%) categories. Seventy-seven surveys were analyzed. In 97.4% of the analyzed surveys, the person surveyed considered the briefings to be useful in improving patient safety; 90.9% considered notification via briefings to be more convenient than through electronic means. In 35.1%, the person surveyed was not satisfied with the information received on incident management. CONCLUSION: Patient safety briefings are perceived as a useful tool to report incidents, and incidents related to communication occur most frequently. Safety briefings are perceived as useful for improving patient safety in pediatric emergency rooms, and this method of notification is considered more convenient than other methods.

Eficacia, seguridad y satisfacción de los procedimientos de sedoanalgesia en las urgencias españolas / Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments

OBJETIVOS: La sedoanalgesia debe ser una prioridad de los servicios de urgencias pediátricas. Analizamos la eficacia y seguridad de los procedimientos de sedoanalgesia así como la satisfacción del personal, pacientes y padres. MÉTODOS: Estudio multicéntrico, prospectivo, observacional y analítico de los procedimientos de sedoanalgesia realizados a niños hasta los 18 años en 18 servicios de urgencias entre febrero de 2015 y enero de 2016. RESULTADOS: Se registraron 658 procedimientos (edad media: 6,8; DE: 4 años). La eficacia fue buena en 483 niños (76,1%; IC 95%: 72,7-79,4%), parcial en 138 (21,7%; IC 95%: 18,5-24,9%) y mala en 14 (2,2%; IC 95%: 1,1-3,4). Se asoció con eficacias mejores la realización por el pediatra de urgencias (OR: 3,14; IC 95%: 1,10-8,95) y un mayor nivel de sedación alcanzado (OR: 2,37; IC 95%: 1,68-3,35). Presentaron eventos adversos precoces 52 (8,4%) niños, siendo los más frecuentes: digestivos, neurológicos y respiratorios (el 89,9% remitieron en < 2 h). Un paciente requirió intubación. La mayor edad y la mayor profundidad de sedación fueron factores de riesgo independientes para presentar eventos adversos (OR: 1,18; IC 95%: 1,09-1,28 y OR: 1,86; IC 95%: 1,22-2,83, respectivamente). Trece niños (5%) presentaron eventos adversos tardíos, siendo el mareo y las náuseas/vómitos los más frecuentes; en todos ellos se usó la combinación midazolam/ketamina (RR: 24,46; IC95%: 11,78-50,76). Registramos la satisfacción percibida (puntuación de 0-10) de 604 profesionales (media: 8,54, DE: 1,95), de 526 padres (media: 8,86; DE: 1,49) y de 402 niños (media: 8,78; DE: 1,70). CONCLUSIONES: Los procedimientos de sedoanalgesia realizados por profesionales entrenados en los servicios de urgencias pediátricas españoles resultan útiles, eficaces y seguros, además de satisfactorios para todos los participantes

OBJECTIVES: To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. METHODS: A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. RESULTS: A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95% CI: 72.7-79.4%), partial in 138 (21.7%; 95% CI: 18.5-24.9%), and poor in 14 (2.2%; 95%CI: 1.1-3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95%C I: 1.10-8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95% CI: 1.68-3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in < 2 h). One patient was intubated. The older child and a deeper level of sedation were found to be independent risk factors for adverse reactions (OR: 1.18; 95% CI: 1.09-1.28 and OR: 1.86; 95% CI: 1.22-2.83, respectively). Thirteen children (5%) developed late adverse drug reactions, more commonly, dizziness and nauseas. A combination of midazolam/ketamine had been used in all the cases (RR: 24.46; 95% CI: 11.78-50.76). The perceived satisfaction level (0-10) was obtained from 604 doctors (mean: 8.54; SD: 1.95), 526 parents (mean: 8.86; SD: 1.49), and 402 children (mean: 8.78; SD: 1.70). CONCLUSIONS: The sedation-analgesia procedure performed in paediatric emergency departments by trained paediatricians seems to be useful, effective and safe, as well as satisfactory for all participants

[Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments]. / Eficacia, seguridad y satisfacción de los procedimientos de sedoanalgesia en las urgencias españolas.

OBJECTIVES: To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. METHODS: A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. RESULTS: A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95%CI: 72.7-79.4%), partial in 138 (21.7%; 95%CI: 18.5-24.9%), and poor in 14 (2.2%; 95%CI: 1.1-3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95%CI: 1.10-8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95%CI: 1.68-3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in <2h). One patient was intubated. The older child and a deeper level of sedation were found to be independent risk factors for adverse reactions (OR: 1.18; 95%CI: 1.09-1.28 and OR: 1.86; 95%CI: 1.22-2.83, respectively). Thirteen children (5%) developed late adverse drug reactions, more commonly, dizziness and nauseas. A combination of midazolam/ketamine had been used in all the cases (RR: 24.46; 95%CI: 11.78-50.76). The perceived satisfaction level (0-10) was obtained from 604 doctors (mean: 8.54; SD: 1.95), 526 parents (mean: 8.86; SD: 1.49), and 402 children (mean: 8.78; SD: 1.70). CONCLUSIONS: The sedation-analgesia procedure performed in paediatric emergency departments by trained paediatricians seems to be useful, effective and safe, as well as satisfactory for all participants.