Developing and Implementing Pediatric Analgesia and Sedation Guidelines at San Francisco General Hospital

A Pediatric Analgesia and Sedation Subcommittee, under the auspices of the San Francisco General Hospital Department of Pediatrics, Quality Assurance Committee, was created and charged with the development of pediatric guidelines. Membership included all health care providers who treated children in all care areas of the hospital: pediatricians, emergency physicians, family practitioners, neurologists, surgeons, intensivists, anesthesiologists, registered nurses, and pharmacists. Guiding principles were that the pediatric pain and sedation guidelines would be effective, easy to employ, based on well-accepted medications, and be child friendly. The focus was to develop analgesia and sedation guidelines for patients undergoing a wide range of medical and surgical procedures. The subcommittee then constructed a series of tables with the appropriate management strategies (including specific medications, doses and delivery routes) for pediatric orthopedic, surgical, and diagnostic procedures, and for sickle cell pain crisis. A detailed account of the implementation of these guidelines is also presented.