2026 Eastern States Conference

Title: Evaluation of an accelerated enteral sedation wean pathway in pediatric patients  

Authors: Emma Covington, PharmD; Steven Astrachan, PharmD, BCPPS; Kathlene DeGregory, PharmD, BCOP; Lynn McDaniel, MD; Michael McCullough, MD; Kira Dubester, MD; Naomi Howard CPNP; Christine Bryant, PharmD, BCPPS 

Learning Objective: After this presentation, the participant will be able to evaluate key interventions and describe how standardized documentation increases utilization of a risk-stratified pediatric sedation wean protocol. 

Background: Pediatric patients with prolonged sedative infusion exposure are at risk for iatrogenic withdrawal syndrome, increasing morbidity, and length of stay. This project aimed to increase utilization of an accelerated wean protocol to ≥75% from 58%. 

Methods: An interdisciplinary quality improvement initiative was conducted using the Plan–Do–Study–Act methodology. Diagnostic evaluation included retrospective chart review from October 2024 through September 2025, process mapping, fishbone analysis, and statistical process control charts to identify sources of variation. 
Interventions implemented in two phases in January 2026 and March 2026 targeted documentation, communication, and clinical decision support. Protocol criteria were broadened, a standardized pharmacist wean initiation note was implemented, and a pediatric intensive care unit (PICU) to floor handoff process was introduced.  
The primary outcome was the proportion of eligible patients initiated on the accelerated pathway. Process measures included risk stratification per protocol and pharmacist note utilization. Balancing measures assessed the expected length of wean compared to actual length of wean as a marker for reduced tolerability. 

Results: From phase one implementation through May 6, 2026, the proportion of patients initiated on the accelerated pathway was __ compared with a baseline of 58%. Pharmacist note utilization was 92% after four months. PICU handoff order utilization was at 0%. Completeness of documentation was assessed by ensuring optional fields were completed, which was 100% at four months. Balancing measures assessed length of wean, seen in one patient, and escalation of care, seen in no patients
. 
Conclusion: Standardizing handoff communication and documentation increased appropriate utilization of an accelerated sedation wean pathway without safety concerns. These interventions were feasible and may improve the reliability of pathway selection and support future outcome evaluation. 

Assessment question: Which is not a potential patient benefit to using an accelerated pediatric sedation wean protocol? 
a. Reduced PICU length of stay
b. Reduced ICU delirium
c. Increased WAT-1 scores
d. Reduced cumulative dose of sedative agents