Safety in Sedation – Not Just Physical

By Laura Mitchell, CCLS

What does “patient safety” mean to you? In the world of pediatric procedural sedation, we consider safety as relating to the physical safety of our patients. We rely on standards of care set forth by The Joint Commission and the Center for Medicare/Medicaid Services. In our own SPS Center of Excellence consensus statement, a heading entitled “Safety” specifies how a Pediatric Sedation Center of Excellence (PSCE) can promote and maintain safe practices. If you were to read a little further in this consensus statement, you would find the heading “Family/Patient Centered”, where the document references recommendations for a PSCE to involve Child Life Specialists, include family, and consider non-pharmacologic adjuncts in the sedation plan of care. But what if we consider psychosocial care, which is recognized as integral to sedation programming, not as a separate intervention disconnected from patient safety but as directly related to the safe care we strive to provide every single day?

The authors of the Emotional Safety Initiative challenge us to begin thinking in just this way. They define Emotional Safety (ES) as “the intentional, interdisciplinary practice to promote resiliency, healing, and trust for pediatric patients and their families during medical experiences.” They cite research which identifies not only that medical experiences can have a traumatic effect on children, but that these traumatic experiences also have the potential to cause healthcare avoidant behaviors in adults. They also thoughtfully explore how healthcare providers are themselves at risk for moral distress by their involvement in these medical experiences. Four Emotional Safety Pillars are identified, each with sub-goals that elaborate on how to reduce the potential for medical stress through purposeful interventions. Though each pillar is connected to our work, Pillar #2 (Intervention) is most closely aligned with pediatric procedural sedation, so much so that similar language can be found in the SPS consensus statement. The sub-goals of the Intervention Pillar are as follows:

• Sub-Goal #1:  Utilize developmentally appropriate and emotionally safe communication styles and tactics.
• Sub-Goal #2:  Implement individualized plans based on the developmental and emotional needs of the patient.
• Sub-Goal #3:  Offer a full array of comfort measures for stressful, anxiety-provoking, or invasive procedures.
• Sub-Goal #4:  Offer a full array of comfort measures during hospitalization.

Through our intention and our advocacy, we are already demonstrating the importance of these interventions. The Emotional Safety Initiative simply helps us to view our work from a different perspective so that we can have better understanding of “the why behind the what” of the care we provide.

To become more familiar with the concept of Emotional Safety, please visit www.emotional-safety.org.

We welcome your thoughts on this topic!