Impact of Developing Adult Ketamine Order Panels for the Emergency Department

Background: Ketamine in adults has been identified as a safe and effective alternative for multiple indications, each with specific evidence-based dosing ranges. Emergency department (ED) providers are tasked with appropriate ordering of ketamine. A multi-institutional retrospective analysis within EDs at a large health system from November 2013 to October 2015 reviewed ED adult ketamine prescribing patterns for procedural sedation (PS), rapid sequence intubation (RSI), and analgesia. Retrospective cohort results revealed 56% (84 of 150) of PS, 64% (16 of 25) of RSI, and 81.5% (53 of 65) of analgesia ketamine doses fell within indication-specific dosing ranges. Objective: The study purpose was to evaluate the impact of standardizing ED ordering processes to increase appropriate dosing of ketamine. Methodology: Indication-specific adult ED ketamine order panels based on available clinical trial data were implemented in the electronic medical record and ED provider education conducted. Adults at least 18 years of age who received ketamine in the ED for PS, RSI, or analgesia from March 2016 to May 2016 were included. Patients were excluded if no weight or indication was documented. The primary outcome was percentage change in frequency of appropriately dosed ketamine versus the retrospective cohort. The secondary outcome was use of ketamine order panels. Mantel-Haenszel tests were used for statistical analysis. Results: Ketamine for prospective cohort adult ED patients was significantly more likely to be dosed appropriately than in the retrospective cohort (odds ratio: 2.94, 95% confidence interval: 1.1-7.8; P = .0231). Conclusion: Results suggest increased standardization with added decision support increased appropriate indication-specific dosing of ketamine for adults in the ED.