582 - Resource Saving Age-based Procedural Sedation Boxes

Acute respiratory compromise during procedural sedation is an infrequent but serious complication. To address this safety concern, a resuscitation bag and mask were expected to be at bedside for every procedural sedation in the emergency department (ED). However, for most sedations these supplies were discarded unused leading to wasted resources.  

Objective:

To reduce waste of resuscitation bags by 25% through the implementation of an age-based sedation box containing resuscitation supplies.  

Design/Methods: The patient population included children between 1 to 18 years with an ASA score of 1 or 2, who needed procedural sedation in the ED. Our baseline period was the year 2021 and the intervention period was the year 2022. The key driver was to promote and optimize reuse of unused resuscitation bags. The interventions were creation of reusable sedation boxes and education of nurses and providers. Standardized age-based sedation boxes (figure 1) for ages 1-6 years, 6-12 years and 12-18 years were created. Each sedation box contained a resuscitation bag with masks secured in an acrylic box that could be cleaned between patients. Education was provided to medical providers and ancillary staff through meetings, emails, and bedside teaching. The outcome measure was number of resuscitation bags used each month. The process measure was the number of sedations each month. Monthly data on resuscitations was also tracked and analyzed in the process measure as this is a confounder for resuscitation bag utilization.

Results: More sedations occurred during summer months, but the number of monthly sedations and resuscitation events did not change year over year. Average monthly resuscitation bag use decreased from 30 during baseline period to 23 during intervention period (figure 2). For every 100 sedations and resuscitations performed, 43 bags were used during baseline period and 28 bags were used during intervention period (figure 3). The absolute reduction in resuscitation bags used in 2022 was 73, a 22.3% reduction.

Conclusion(s): Implementation of the reusable sedation box resulted in waste reduction associated with resuscitation bags. The use of these age-based standardized sedation boxes can be implemented in all EDs and sedation suites, saving resources one bag at a time.