Guideline for Midazolam Administration in Preoperative Pediatric Patients

Abstract

Problem: In a small community hospital a protocol did not exist for the administration of midazolam for preoperative pediatric patients, resulting in the child not receiving pre-operative anxiolytics. The most common treatment for preoperative anxiety is midazolam. Less than 50% of pediatric patients receive midazolam before surgery at this facility. Purpose: The purpose of this quality improvement project was to implement and evaluate the utilization of a guideline for the administration of midazolam in the pediatric preoperative setting. Methods: The initiative was implemented over a 15-week period in the Fall of 2022. The planned intervention consisted of two parts: a protocol incorporating an education bundle for nurses about midazolam and an order set in the electronic medical record for anesthesia staff. Nursing staff education and anesthesia staff education was disseminated via email and in person. Data was collected on a weekly basis. Results: If midazolam was ordered, 100% of pediatric patients received the medication. The nurses felt comfortable administering the medication and were satisfied with the guideline. Thirty-four children (65%) qualified to receive midazolam, but only 59% of them had an order present and received the medication (n=20). Conclusions: The literature supports the use of midazolam for pediatric preoperative anxiolysis and is attributed to a smooth induction and emergence. The data found 100% of the nurses who responded to the survey benefited from the midazolam education and guideline. Of the children who met inclusion criteria and had an order present, 100% receive the medication for anxiolysis. Post education of anesthesia providers correlated with an increase in midazolam orders. Limitations to this quality improvement project included the anesthesia providers preference of midazolam administration and a limited number of scheduled pediatric cases.