P27
SLEEPY SPRAY SAVES THE DAY! A PROSPECTIVE IMPACT EVALUATION DURING THE INTRODUCTION OF INTRANASAL DEXMEDETOMIDINE PREMEDICATION ON STAKEHOLDER PERI-OPERATIVE EXPERIENCE
A.Norris, T. Blanks
Nottingham University Hospitals NHS Trust, UK
Background/Context
The rate of Paediatric Medical Traumatic Stress leading to long-term behavioural change post-operatively is 13 to 35%[1]. Peri-operative anxiety increases emergence delirium (ED), nausea and vomiting (PONV) and post-operative pain(POP)[2]. Methods of peri-operative anxiolysis include non-pharmacological and pharmacological methods; the administration and effects of which can impact patient, caregiver and staff experience.
Problem
Patient experience is a key quality indicator in healthcare and a pillar of driving quality improvement in our trust. This impact evaluation assessed whether patient, caregiver and staff experiences were improved during the introduction of using intranasal dexmedetomidine (IN DEX) as premedication, with comparison to oral midazolam.
Strategy for Change
Over 4-weeks in May 2023 elective day-case patients admitted through our tertiary centre Children’s Ambulatory Care Unit were prospectively evaluated. All those receiving premedication with oral midazolam (0.5mg/kg, n=21) or IN DEX (2-4mcg/kg via nasal atomiser, n=24) had a patient experience questionnaire completed by the patient/caregiver and perioperative nurses. A modified PESaM[3] questionnaire identified: (a) ease of administration; (b) perceived effectiveness; (c) side effects; (d)impact of medication on experience.
Measure of Improvement
(a) IN DEX was easy to administer by nurses in 96% (23/24) cases, vs 57% (12/21) of oral midazolam. (b) IN DEX was deemed effective anxiolysis by caregivers and nurses in 92% (22/24), vs midazolam 72%(15/21) by nurses and 76%(16/21) by caregivers. (c) IN DEX had no respiratory complications, POP, PONV or ED; midazolam had 1x laryngospasm, 1x PONV and 4x ED (19%, 4/21). Caregivers reported IN DEX as having a positive impact on the child’s experience in 96% (23/24) of cases, vs 72% (15/21) of oral midazolam. In children historically receiving oral midazolam, 100% (7/7) reported a better experience of IN DEX premedication.
Lessons Learnt/Message
Our evaluation demonstrates a positive impact on experience following introduction of IN DEX as premedication in the anxious/stressed child at our trust. Easier administration of IN DEX contributes to increased effectiveness: these rates similar to reported meta-analyses[4]. In combination with a low side effect profile, this leads to high reporting of positive impacts on patient experience. Beyond this initial evaluation on stakeholder experience, we continue to analyse other key outcomes quarterly at our trust, including safety, length of stay and other cost savings.
References
[1] Stanzel,A. (2022). Paediatric Medical Traumatic Stress (PMTS) following surgery - J. Child Adolesc Trauma. Vol 15(3):795-809.
[2] Muhly,T. (2020). A Systematic Review Of Outcomes Reported In Pediatric Perioperative Research - Pediatric Anesthesia. Vol 30 11:1166-1182.
[3] Kimman,M. (2017). Development and Pretesting of a Questionnaire to Assess Patient Experiences and Satisfaction with Medications (PESaM Questionnaire). Patient. Vol 10(5):629-642.
[4] Tervonen.M. (2020). Systematic Review and Meta Analysis Found That Intranasal Dexmedetomidine Was Safe And Effective Sedation - ActaPaediatrica. Vol 109(10):2008-2016.