Nembutal® vs. Precedex® in Pediatric Imaging Sedation: Using comparative clinical, process flow, and finance data to influence change

Clegg, Shannon Francis-

Monday, 18 November 2013

Shannon Francis- Clegg, BSN, MBA
Primary Children's Medical Center Imaging Sedation Department, Intermountain Healthcare--Primary Children's Medical Center, Salt Lake City, UT

Learning Objective 1: The learner will be able to list at least three clinical response variances between pediatric patients given Nembutal® OR Precedex® for sedation.

Learning Objective 2: The learner will be able to verbalize three quality and/or process changes made in patient care as a result of comparative data obtained.

During the past few decades, Precedex® (Dexmetomidine) has begun to be used more frequently for procedural and imaging pediatric sedation. In 2009, the nurse practitioners, who are responsible for sedation orders in the Imaging Department at Primary Children’s Medical Center, began utilizing this medication in addition to the traditional use of Nembutal® (Pentobarbital Sodium). Since then, depending on the patient’s age, weight, clinical history and/or practitioner preference, Pentobarbital Sodium (NEMBUTAL®) OR Dexmedetomidine (Precedex®) is ordered as the primary sedative agent. Registered nurses administer and monitor the ordered sedation. After the change, the nurses perceived that NEMBUTAL® provided more stable patient clinical parameters, less use of adjunctive medications, less fluid support, fewer process delays, and a lower provisional cost than Dexmedetomidine (Precedex®). Literature review provided important information regarding these two medications but no article could be found specifically comparing these medications during longer imaging exams (MRI/Nuclear Medicine) for clinical response, process flow and financial variances. A prospective quality data analysis study was conducted by the nursing staff between September 2011 – December 2012 on 1700 pediatric patients ≥ 6 months - ≤ 7 years 364 days of age, after provision of a sedated MRI or Nuclear medicine exam. Ordering practitioners had no access to the data during the study so as not to bias their normal ordering practices. The data obtained has been and/or will be used to define and reduce adverse clinical responses, adjust clinical management, clarify process flow concerns, decrease patient flow delays, decrease equipment downtime, and make recommendations to improve provisional expense and reimbursement.

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