P2.282: Improving Sedation Process in a Pediatric Emergency Department in Puerto Rico

Purpose/Objectives: This Quality Improvement (QI) project aims to enhance procedural sedation documentation by implementing standardized tools and processes to improve consistency and completeness in a Pediatric Emergency Department in Puerto Rico. Specific objectives include increasing documentation rates—including physician procedure notes, procedure orders, and nursing procedure notes—to at least 85% within three-month cycles and identifying barriers to documentation to implement targeted interventions effectively.

Design/Methods: Gaps in standardized documentation and lack of provider awareness were identified through staff surveys and departmental meetings in the Pediatric Emergency Department. A retrospective chart review of procedural sedations performed between October 2023 and March 2024 established baseline metrics. We developed and implemented targeted interventions in three-month cycles, including educational sessions in resident’s didactics, training sessions to nursing staff, the revision and modification of the existing informed consent and electronic medical record (EMR) order set, implementation of standardized documentation tools such a time-out checklist, and a revision of the existing protocol based on identified gaps, available resources, and established guidelines.

Results: Baseline data from the retrospective chart review showed that physician procedure notes were documented in 33% of cases, procedure orders in 59%, and nursing procedure notes in 52%. A needs assessment survey revealed that 57% of residents were unaware of an existing standardized order set in the EMR, and only 32% consistently documented a procedure note. Post-interventions, documentation rates improved to 51% for physician procedure notes, 87% for procedure orders, and 76% for nursing procedure notes. A follow-up survey indicated that 44% of residents reported writing a physician procedure note only sometimes, with 42% attributing lapses to forgetfulness.

Conclusion/Discussion: A needs assessment and retrospective chart review identified significant gaps in procedural sedation documentation at the Emergency Department of the Pediatric University Hospital of Puerto Rico. Through targeted interventions, we improved documentation rates, particularly for procedure orders and nursing procedure notes. Despite these gains, physician documentation remains an area for further improvement. Future efforts will focus on reinforcing adherence through continued education, reminders, and workflow integration strategies to ensure sustainable progress.