G568(P) Sedation for mri/cy: a service improvement project

• Published in: Archives of disease in childhood 2015-04, Vol.100 (Suppl 3), p.A256-A257
• Main Authors: Collins, ME, Shields, BJ
• Format: Article
• Language: English
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2015-308599.517

ContextThe information for this project was collected from the children's wards at UHCW. Patients attending for elective scans requiring sedation were included. Sedation was administered as per the trust protocol. This protocol is based on current NICE and BNFc guidance.Weight 15 kg - Midazolam sedationProblemWe found that sedation of children for elective MRI/CT scans was insufficient more often than not. This led to failed scans which in turn led to delays in diagnosis, stress for patients and families. In addition this incurred significant financial cost to the Trust due to failed scans and referrals to BCH for scans under GA.Assessment of problem and analysis of its causes60 scans were reviewed over a 6 month period in 2013. 38 children underwent midazolam sedation and 22 were given chloral hydrate.Chloral hydrate sedation was successful in 90% of cases, whereas midazolam was only successful in 18% of cases.After discussion with the finance department we calculated that failed scans combined with referrals to BCH was costing the trust c. pound sterling 70,000 per year.InterventionWe have discontinued the use of midazolam sedation for MRI/CT scansThe trust is in the process of developing a paediatric GA scan service at UHCWStrategy for changeThe initial results of the study were presented to the paediatric department at the monthly clinical audit meeting. After discussion, the decision to stop using midazolam for scan sedation was disseminated amongst community and hospital based paediatricians.A multi-disciplinary team comprising paediatricians, radiographers, radiologists and anaesthetists was formed. This team is in the process of designing and trialling a GA scan service at UHCW. This will enable us to provide scans to children who would beforehand have probably had 1-2 failed scans and then been referred to BCH. In addition this service may also provide the trust with increased revenue and savings.Measurement of improvementWe now only have children weighing 15 kgs that require sedation are being referred directly to BCH for GA scans while we develop our own service. This ensures that they will not need to undergo a probably unsuccessful scan under sedation with us before being referred.Effects of changesDiscontinuing the use of midazolam sedation has prevented children undergoing a stressful procedur