Start with Topical Anaesthesia, Replacing Procedural Sedation

Initiative Type
Service Improvement
Status
Deliver
Added
11 March 2022
Last updated
26 July 2022

Summary

This PROV-ED initiative promotes a specific technique to optimise the use of topical anaesthetic gel for effective pain relief of certain skin lacerations, aiming to reduce the need for procedural sedation. 
It is particularly applicable to the paediatric setting but can also be used in other patient cohorts.
 

Key dates
Jul 2021
Implementation sites
The Prince Charles Hospital Children’s Emergency Department (pilot implementation) - 2018

Aim

To educate staff on a specific technique to use topical anaesthetic with an aim to replace the need for procedural sedation for repair of certain types of skin lacerations.

Benefits

  • reduced patient length of stays (90 mins vs 5-6 hours), thereby reducing bed pressures
  • less distress to patients and carers
  • cost savings
  • released staff time
  • improved staff satisfaction.
     

Background

Nurse practitioner Louise Spooner piloted this technique at The Prince Charles Hospital Children’s Emergency Department (ED) in response to the fact that children presenting to the ED with lacerations needing suturing often require procedural sedation, and sometimes inter-facility transfer  to effectively manage the pain and enable wound closure.

Topical anaesthetic has been widely used for pain reduction in laceration injuries, however it is less commonly used to the extent to replace procedural sedation. A Standing Order was introduced to recommend a specific technique using topical anaesthetic (Laceraine®), accompanied by a staff education campaign. 

Solutions Implemented

Following engagement with the PROV-ED Project Team, a toolkit of resources will be provided including: 

  • generic Standing Order Document to be customised for each facility
  • staff education video and PowerPoint presentation
  • implementation guide.
     

Evaluation and Results

A post-implementation audit at TPCH Children’s ED demonstrated a 30 per cent reduction in paediatric patients with a laceration requiring suturing or stapling who underwent procedural sedation. Evaluation under PROV-ED will measure rates of procedural sedation associated with potentially applicable skin lacerations pre- and post-implementation of STARS.

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Key contact

PROV-ED Project
Manager, PROV-ED
Healthcare Improvement Unit
07 3646 0775/ 07 3646 5005
Proved.Project@health.qld.gov.au