Program Brochure - Society for Pediatric Sedation

JOINTLY SPONSORED BY
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Scientific Program Information
NURSES
Provider: Kosair Children’s Hospital - Expiration Date: 12/31/2011
Kentucky Board of Nursing approval of an individual nursing continuing education program does not constitute endorsement of program
content. Nursing participants shall attend the entire session and complete the evaluation form. No partial credit can be given. Each attendee
must provide license number or employee ID (for Norton Healthcare
employees) at time of registration. Refer to each activity’s description
below for designation of number of contact hours. For questions related
to nursing credit, please contact Debora Williams BSN, RN-BC, Clinical Education at Kosair Children’s Hospital at phone: (502) 629-7359,
fax: (502) 629-8827 or email: Debbie.williams@nortonhealthcare.org.
Approved by the Kentucky Board of Nursing (KBN) for:
Sunday, May 23, 2010 (Day 1): 4-0008-12-11-326 for 6.75 contact hours.
Monday, May 24, 2010 (Day 2): 4-0008-12-11-327 for 6 contact hours.
Tuesday, May 25, 2010 (Day 3): 4-0008-12-11-328 for 7.75 contact hours.
Faculty Disclosure
Norton Healthcare adheres to the Kentucky Medical Association Essential Areas and Policies, including the Standards for Commercial Support,
regarding industry support of continuing medical education (CME). All
individuals in a position to control the content of this educational activity (course directors, planners, presenters) must disclose all relevant
financial relationships they have with commercial interests, as well as
the nature of any relationship, that may be a potential conflict of interest
during the planning process. These are assessed by the Office of CME to
ensure adequate resolution of any identified conflicts prior to the activity.
Disclosure of faculty and commercial relationships, as well as the discussion of unlabeled or unapproved use of any drug, device or procedure
by the faculty, will be disclosed onsite to activity participants. Further,
participants will be asked to evaluate all speakers’ content for bias and
balance at the activity.
Special Needs
Norton Healthcare is committed to making its conference accessible to
all individuals. If you have a disability, please provide a description of
any auxillary aids or services (identified in the Americans with Disabilities
Act) needed at the time of registration. Most requests for aids or services
can be obliged.
Target Audience
Procedural sedation increasingly impacts many aspects of pediatric medical care and sedation providers include professionals from a broadening
range of disciplines. This educational activity is intended for any health
care provider interested in or who provides pediatric procedural sedation including physicians (any subspecialty), dentists, nurses, advanced
practice nurses, nurse anesthetists and other health professionals.
Statement of Need
Significant variability exists between the medical care models currently
employed in the delivery of pediatric sedation. However, based on responses from prior sedation conferences, themes/questions posed to/on
sedation discussion forums, and current published literature, sedation
providers continue to desire greater understanding of the elements of
optimal sedation delivery systems, how those elements relate to their
own individual organizational structures, and how these elements can
be incorporated into provider training and practices. These venues have
also identified a need for a better understanding of the sedation needs
of sub-populations of pediatric patients with unique needs as well as the
overall processes involved in the pre-sedation assessment, patient selection, intra-sedation and post-sedation care.
Purpose
Participants will develop an understanding of care delivery models in
pediatric sedation, in terms of their organizational structure, business
practices, credentialing of providers, patient selection and medical practices. This knowledge will allow sedation providers to evaluate and adjust
their practice models and/or individual clinical practices within which they
currently function, or are in the process of building. Participants will also
obtain a better understanding of practical issues in delivering sedation
care, including selection of sedation agents, pre-, intra- and post-sedation care, and sedation education processes, all of which will enhance
participants subsequent clinical sedation practices. The additional skills
and knowledge participants will gain on both the levels of systems design
and of individual practice will result in improved, safer patient care.
Overall Conference Objectives
Upon completion of this course, the participant will be able to describe
the critical elements of the existing care models in institutions that practice pediatric sedation, discuss methods for evaluation and optimization
of existing sedation care models, discuss decision making regarding patient selection and the development of a sedation plan from the perspective of the different subspecialties that practice pediatric sedation. Participants will be able to discuss important practical issues in the delivery
of pediatric sedation care, including the selection of sedation agents and
monitoring modalities as well as the increasing role of simulator technology in sedation practice education and credentialing.
Continuing Education Credits
PHYSICIANS
This CME activity has been planned and implemented in accordance
with the Essential Areas and Policies of the Kentucky Medical Association through the joint sponsorship of Norton Healthcare and the Pediatric
Sedation Society.
Accreditation: Norton Healthcare is accredited by the Kentucky Medical
Association to sponsor continuing medical education for physicians.
Designation: Norton Healthcare designates this educational activity for
a maximum of 20.00 AMA PRA Category 1 CreditsTM (6.75 credits on
Sunday, 5.5 credits on Monday, 7.75 credits on Tuesday). Physicians
should only claim credit commensurate with the extent of their
participation in the activity. Physicians are required to sign in daily.
Online Hotel Reservation Information
Urban flair blends seamlessly with southern hospitality at the Hyatt Regency Louisville. Our renowned service, welcoming staff and prime setting make us the continued favorite among Louisville, Kentucky hotels.
A special web page has been established for guests of Pediatric Sedation Conference. To make online hotel reservations, visit https://resweb.
passkey.com/go/sps2010.
The SPS group rates are $129.00 - single/double, $154 - triple, $174 quad. Rates are exclusive of applicable state and local taxes, currently
at 15.01%. Reservations may be made online or by calling 1-888-4211442. To receive the group rate, be sure to mention SPS when making
your reservations. Hyatt Regency Louisville is located at 320 West Jefferson, Louisville, KY 40202.
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Sedation Provider Course
SUNDAY, MAY 23, 2010
7:00 am - 7:30 am
Registration and Continental Breakfast
7:30 am - 7:45 am
Introduction
Gregory Hollman, MD
7:45 am - 8:30 am
Pre-Sedation Phase and Assessment
Patricia D. Scherrer, MD
8:30 am - 8:45 am
Case Scenarios Session Introduction
Aaron Calhoun, MD; Akira Nishisaki, MD
8:45 am - 10:15 am
CASE SCENARIOS SESSION I
Apnea/Hypoventilation, Airway Obstruction
10:15 am - 10:30 am
Coffee Break
10:30 am - 12:00 n
CASE SCENARIOS SESSION II
Secretions/Aspirations, Hemodynamic Changes
12:00 n - 12:45 pm
Lunch
12:45 pm - 1:45 pm
Sedation Phase
John W. Berkenbosch, MD
1:45 pm - 4:45 pm
CORE PATIENT SCENARIOS
4:45 pm - 5:30 pm
Testing
Sedation Provider Course Information
Target Audience
The target audience for the Sedation Provider Course includes health care
providers who have clinical experience in the area of pediatric sedation
and who desire to enhance their knowledge and clinical competency in
the field. This group includes physicians, nurses and advance-practice
nurses involved in the field of pediatric sedation
Statement of Need
This course is designed to meet the needs of the sedation provider
seeking both practical (simulation) training and didactic content focused
on patient selection, patient safety, pharmacology and the management
of common adverse events. As significant adverse events are rare, this
“hands-on” model of training is especially pertinent.
Purpose
Participants will gain clinical skills and a deeper understanding regarding
issues related to the assessment of sedation patients, development
of a sedation plan, recognition and management of both common
and life-threatening adverse events in sedation practice and sedation
pharmacology. This course is designed to provide practitioners with the
knowledge, competencies and skills that promote safe and effective
high-quality procedural sedation to children.
Objectives
The goal of the provider course is to provide practitioners with the
knowledge, competencies and tools to promote high quality procedural
sedation to children. Upon successful completion of this course, the
registrant should be able to:
1. Perform a pre-sedation risk assessment;
2. Describe the effects of sedation on airway control and respiratory
drive;
3. Explain the principles of and interpret the information from pulse
oximetry and capnography;
4. Define, diagnose and treat adverse airway and cardiopulmonary
events during sedation;
5. Recognize pharmacologic concerns when using common sedative
drugs;
6. Apply core case scenarios related to sedated pediatric patients
including all aspects of airway management, ventilation, resource
management, and appropriate use of resuscitative measures;
7. Develop a systematic and rational approach to pediatric sedation.
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S O C I E T Y O F P E D I AT R I C S E D AT I O N
SPS
SOCIETY FOR PEDIATRIC SEDATION
safe and sound
5th International Multidisciplinary
Conference on Pediatric Sedation
May 23-25, 2010 • Hyatt Regency Louisville • Louisville, KY
Scientific Program
MONDAY, MAY 24, 2010
7:00 am - 5:00 pm
Registration
7:00 am - 7:45 am
Continental Breakfast
7:45 am - 8:15 am
Welcome and Opening Remarks
John W. Berkenbosch, MD, FAAP, FRCPC, FCCM; Therese Sirles, MS, RN, CPN; Joseph P. Cravero, MD
8:15 am - 9:00 am
Opening Keynote: Moving Sedation Forward - Maturing from Infancy to Adolescence
J. Michael Connors, MD
9:00 am - 9:30 am
Coffee Break with Exhibitors
9:30 am - 11:00 am
New Avenues for Pediatric Sedation
9:30 am - 10:15 am Sedation for Interventional Radiology
Kevin M. Baskin, MD
10:15 am - 11:00 am Sedation for Cardiac MRI
Jeffrey Linzer, Sr., MD, FAAP, FACEP
11:00 am - 12:00 n
The Future of Sedation-Based Research
Amy L. Baxter, MD, FAAP, FACEP
12:00 n - 1:30 pm
Lunch on Your Own
1:30 pm - 2:15 pm
The Role of the RN in Sedation Provision
Keith Fishlock, MSN, CPN, CRN
2:15 pm - 3:00 pm
Breakouts (See listing on page 5)
3:15 pm - 3:30 pm
Coffee Break with Exhibitors
3:30 pm - 4:15 pm
Breakouts (See listing on page 5)
4:30 pm - 5:30 pm
Tour of Kosair Children’s Hospital Sedation Unit
7:00 pm - 9:00 pm
Welcome Reception and Poster Session - Hyatt Regency Louisville
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Scientific Program
TUESDAY, MAY 25, 2010
7:00 am - 5:00 pm
Registration
7:00 am - 8:00 am
Continental Breakfast
8:00 am - 8:45 am
Keynote: Old Drug, New Questions - What’s Up with Ketamine?
Robert M. (Bo) Kennedy, MD
8:45 am - 9:45 am
Special Problems in Sedation
8:45 am - 9:15 am
Sedation of the Obese Child
Benjamin D. Greenberg, MD
9:15 am - 9:45 am The Child with Acute Respiratory Co-Morbidities
Lia Lowrie, MD
9:45 am - 10:15 am
Coffee Break with Exhibitors
10:15 am -12:15 pm
RESEARCH TRACK
NURSING TRACK
Advancing the Role of the Sedation RN
10:15 am - 11:00 am Sedation Year in Review
Philip A. Bernard, MD
Susanne Kost, MD, FAAP, FACEP
Jeana E. Havidich, MD, FAAP
10:15 am - 10:50 am First Contact - The Pre-Sedation
Assessment
Deborah LaViolette, RN, CPN
11:00 am - 12:15 pm Oral Poster
Presentations
James H. Hertzog, MD
10:50 am - 11:25 am Intraprocedure Responsibilities:
Medication Administration and
Monitoring
Emily M. McRae, MSN, ARNP
11:25 am - 12:00 n
Recovery and Beyond:
Post-Sedation Monitoring and
Discharge Readiness
Kelly Jedlicki, ARNP
12:00 n- 12:15 pm
Discussion
Kelly Jedlicki, ARNP
Deborah LaViolette, RN, CPN
Emily M. McRae, MSN, ARNP
12:15 pm - 1:30 pm
Lunch Lecture: The Role of Simulation in Sedation Education
Joseph P. Cravero, MD
1:30 pm - 3:00 pm
Old(er) Drugs, New Frontiers
1:30 pm - 2:15 pm
Nitrous Oxide
Joseph D. Tobias, MD
2:15 pm - 3:00 pm
Dexmedetomidine
Jennifer Schoonover, CPNP-PC, AC; John W. Berkenbosch, MD, FAAP, FRCPC, FCCM
3:00 pm - 3:30 pm
Coffee Break with Exhibitors
3:30 pm - 4:15 pm
Breakouts (See listing on page 5)
4:15 pm - 5:00 pm
Breakouts (See listing on page 5)
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Conference Breakout Sessions
1. The Business of Sedation
Therese M. Sirles, MS, RN, CPN; Lisa Atwell Tong, RN, MSN
Objective: Upon completion of this course, participants will recognize the impact and importance of sedation unit design on sedation
provision, patient flow, safety and how these outcomes impact sedation unit administration.
2. Sedation to Facilitate Ultrasound
Susanne Kost, MD, FAAP, FACEP
Objective: Upon completion of this course, participants will be able to describe the unique aspects of sedation for specific radiologic
procedures, including ultrasound, and how sedative choices impact the ability to perform these procedures safely and effectively.
3. ABC’s of Sedation-Based Research
John W. Berkenbosch, MD, FAAP, FRCPC, FCCM
Objective: Upon completion of this course, participants will be able to review the importance of continuing to perform high quality
sedation-based research, discuss hurdles in performing this research, and provide the learner with concrete suggestions about how
to engage in high quality sedation-based research activities.
4. Choosing the Idea Sedation Agent
Patricia D. Scherrer, MD; Jana A. Stockwell, MD, FAAP, FCCM
Objective: Upon completion of this course, participants will be able to summarize issues related to sedative agent choice in a variety
of sedation venues/settings. Discussion will focus on decision factors related to choosing agents for certain procedures (invasive vs
non-invasive, short vs long-duration) as well as specific patient populations (age spectrum, the combative child for example).
5. RN-Related Issues in Credentialing/Competencies
Deborah LaViolette, RN, CPN
Objective: Upon completion of this course, participants will be able to demonstrate the roles required by the nurse sedation provider
during different aspects of the sedation encounter. Specific focus will also be made on how to provide education/training related to
these skill sets as well as how to work with institution administration to verify the maintenance of these competencies/skill sets.
6. Non-Pharmacologic Adjuncts
Amy L. Baxter, MD, FAAP, FACEP; Verlinda Thompson, MA
Objective: Upon completion of this course, participants will be able to discuss the importance of non-pharmacologic adjuncts in
aiding with the sedation encounter, including how to utilize these adjuncts to either decrease or even possibly eliminate the need for
pharmacologic sedation to facilitate procedure completion.
7. Family-Centered Sedation
Frankie Gilliland, ARNP, MSN, CCRN; Amy Graf, ARNP
Objective: Upon completion of this course, participants will be able to compare the pros and cons of parental presence during the
sedation encounter. Specific issues will include discussion of balancing the stress on the parents or child of being present or absent
during the procedure against the impact of parental presence on the ability of the sedation provider to safely provide sedation.
8. Emergent Sedation Requests
Mary A. Hegenbarth, MD, FAAP, FACEP; Marc Leder, MD; Daniel M. Cohen, MD
Objective: Upon completion of this course, participants will be able to examine patients requiring sedation emergently, who have
presumably not met NPO guidelines and how these issues impact sedative agent and technique choices and patient monitoring
requirements.
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Sedation Provider Course Faculty
David Banks, MD
David Fagin, MD
John W. Berkenbosch, MD, FAAP,
FRCPC, FCCM - Program Co-Chair
Kiran Hebbar, MD
Pediatric Emergency Medicine
Pediatric Emergency Medicine
Associates LLC
Children’s Healthcare of Atlanta
Atlanta, GA
Professor, Pediatrics/Pediatric Critical Care
Kosair Children’s Hospital
Louisville, KY
Philip A. Bernard, MD
Pediatric Critical Care
Kentucky Children’s Hospital
University of Kentucky
Lexington, KY
Megan Boone, RN
Kosair Children’s Hospital
Louisville, KY
Aaron Calhoun, MD
Assistant Professor of Pediatrics
University of Louisville
Louisville, KY
Joseph P. Cravero, MD
Professor, Anesthesiology and Pediatrics
Dartmouth-Hitchcock Medical Center
Lebanon, NH
Assistant Medical Director
Emergency Services
Scottish Rite Hospital / Childrens
Healthcare of Atlanta
Atlanta, GA
Assistant Professor of Pediatrics
Medical Director TICU, Children’s Healthcare
of Atlanta at Egleston
Director of Pediatric Education and
Development through Simulation Program (PEDSIM)
Emory University School of Medicine
Atlanta, GA
Gregory Hollman, MD
Professor of Pediatrics
University of Wisconsin School
of Medicine and Public Health
Medical Director Diagnostic
and Therapy Center
American Family Children’s Hospital
Madison, WI
Jen Hopkins, MD
Assistant Professor of Pediatrics
University of Louisville
Louisville, KY
Lia Lowrie, MD
Chief, Division of Pediatric Critical Care
Medicine Associate Professor of Pediatrics, Case
Western Reserve University
School of Medicine
Rainbow Babies and Children’s Hospital
Cleveland, OH
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Kevin Martin
Director of Operations
Paris Simulation Center
University of Louisville
Louisville, KY
Akira Nishisaki, MD
Associate Director Center for Simulation
Advanced Education and Innovation
Attending Physician
Department of Anesthesiology
and Critical Care Medicine
The Children’s Hospital of Philadelphia
Philadelphia, PA
Michael Ruppe, MD
Assistant Professor of Pediatrics
University of Louisville
Louisville, KY
Patricia D. Scherrer, MD
Medical Director, Pediatric Sedation
Children’s Hospital Minneapolis
Children’s Hospitals and Clinics of Minnesota
St. Paul, MN
Therese M. Sirles, MS, RN, CPN
Program Co-Chair
Director of Child Advocacy
Kosair Children’s Hospital
Louisville, KY
Anne Stormorken, MD
Rainbow Babies and Children’s Hospital
Cleveland, OH
Program Faculty
John W. Berkenbosch, MD, FAAP, FRCPC,
FCCM - Program Co-Chair
Professor, Pediatrics/Pediatric Critical Care
Kosair Children’s Hospital
Louisville, KY
Therese M. Sirles, MS, RN, CPN
Program Co-Chair
Director of Child Advocacy
Kosair Children’s Hospital
Louisville, KY
Joseph P. Cravero, MD
Program Co-Chair
Professor, Anesthesiology and Pediatrics
Dartmouth-Hitchcock Medical Center
Lebanon, NH
Pediatric Anesthesiology
Kevin M. Baskin, MD
Division Chief, Pediatric Interventional Radiology
Department of Pediatric Radiology
Children’s Hospital of Pittsburgh
Pittsburgh, PA
Amy L. Baxter, MD, FAAP, FACEP
Director of Emergency Research
Pediatric Emergency Medicine Associates
Atlanta, GA
Pediatric Emergency Medicine
Philip A. Bernard, MD
Assistant Professor of Pediatrics
University of Kentucky
Lexington, KY
Pediatric Critical Care
Daniel M. Cohen, MD
Associate Professor of Clinical Pediatrics
Nationwide Children’s Hospital
Columbus, OH
Pediatric Emergency Medicine
J. Michael Connors, MD
President, Pediatric Analgesia
& Sedation Specialists, PLLC
East Tennessee Children’s Hospital
Knoxville, TN
Pediatric Emergency Medicine
Keith Fishlock, MSN, PCNS-BC
Pediatric Clinical Nurse Specialist
Department of Day Medicine
Nemours/Alfred I duPont Hospital for Children
Pediatrics and Radiology
Wilmington, DE
Frankie Gilliland, ARNP, MSN, CCRN
University of Louisville
Louisville, KY
Pediatric Critical Care
Amy Graf, ARNP
Kosair Children’s Hospital
Louisville, KY
Pediatric Procedural Sedation
Benjamin D. Greenberg, MD
Attending Anesthesiologist
Kosair Children’s Hospital
Louisville, KY
Pediatric Anesthesiology
Jeffrey Linzer, Sr., MD, FAAP, FACEP
Co-Director, Children’s Sedation Service
Children’s Healthcare of Atlanta
Associate Professor of Pediatrics and
Emergency Medicine Emory University
Atlanta, GA
Pediatric Emergency Medicine
Lia Lowrie, MD
Department of Anesthesiology
Dartmouth-Hitchcock Medical Center
Lebanon, NH
Pediatric Anesthesiology
Division Chief, Pediatric Critical Care Medicine
Associate Professor of Pediatrics
Case Western Reserve University
School of Medicine
Rainbow Babies and Children’s Hospital
Cleveland, OH
Pediatric Critical Care
Mary A. Hegenbarth, MD, FAAP, FACEP
Emily M. McRae, MSN, ARNP
Jeana E. Havidich, MD, FAAP
Children’s Mercy Hospital/University of MissouriKansas City School of Medicine
Section of Emergency Medicine
Kansas City, MO
Pediatric Emergency Medicine
James H. Hertzog, MD
Pediatric Intensivist
Alfred I. duPont Hospital for Children
Wilmington, DE
Associate Professor of Pediatrics
Jefferson Medical College
Philadelphia, PA
Pediatric Critical Care Medicine
Kelly Jedlicki, ARNP
Kosair Children’s Hospital
Louisville, KY
Pediatric Procedural Sedation
Robert M. (Bo) Kennedy, MD
Professor, Department of Pediatrics
St. Louis Children’s Hospital, Washington
University School of Medicine
St. Louis, MO
Pediatric Emergency Medicine
Susanne Kost, MD, FAAP, FACEP
Associate Professor of Pediatrics
Nemours/A.I.duPont Hospital for Children
Wilmington, DE
Pediatric Emergency Medicine
Deborah LaViolette, RN, CPN
Clinical Manager, Pediatric Procedural
Sedation Service
Georgetown University Hospital
Washington, DC
Pediatric Sedation
Marc Leder, MD
Associate Professor of Clinical Pediatrics
The Ohio State University
Nationwide Children’s Hospital
Columbus, OH
Pediatric Emergency Medicine
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University of Louisville
Louisville, Kentucky
Pediatric Critical Care
Patricia D. Scherrer, MD
Medical Director, Pediatric Sedation
Children’s Hospital Minneapolis
Children’s Hospitals and Clinics
of Minnesota
St. Paul, MN
Pediatric Critical Care Medicine
Jennifer Schoonover, CPNP-PC, AC
Kosair Children’s Hospital
Louisville, KY
Pediatric Procedural Sedation
Jana A. Stockwell, MD, FAAP, FCCM
Interim Director
Pediatric Critical Care Medicine
Emory University School of Medicine
Co-Director, Children’s Sedation Services
Children’s Healthcare of Atlanta at Egleston
Atlanta, GA
Pediatric Critical Care
Verlinda Thompson, MA
Child Life Specialist
Kosair Children’s Hospital
Louisville KY
Child Life
Joseph D. Tobias, MD
Department of Anesthesiology and Pain Medicine
Nationwide Children’s Hospital
Columbus, OH
Pediatric Anesthesiology
Lisa Atwell Tong, RN, MSN
Director, Surgical and Sedation Services
Kosair Children’s Hospital
Louisville, KY
Pediatric Surgical and Sedation Nursing
Practice and Leadership
SPS
SOCIETY FOR PEDIATRIC SEDATION
safe and sound
5th International Multidisciplinary
Conference on Pediatric Sedation
May 23-25, 2010 • Hyatt Regency Louisville • Louisville, KY
CME provided by Norton Healthcare
REGISTRATION FORM
2209 Dickens Road, Richmond, VA 23230-2005 • (804) 565-6354 • Fax (804) 282-0090 • sps@societyhq.com
Online registration available at www.pedsedation.org.
First Name:_____________________________ Last Name:_______________________________________ Title:_ ________________
Address:_ ___________________________________________________________________________________________________
City/State/Zip:___________________________________________ Email:________________________________________________
Phone:________________________________________________ Fax: __________________________________________________
Registration Policy: All attendees must pay a registration fee to attend any SPS event unless otherwise noted below. Badges are required for entrance to all scientific session and social functions. Registration fees include: E-Syllabus, Welcome Reception, Continental
Breakfast, Coffee Breaks and one Lunch. Fees are per person. Please complete all areas on this form.
Registration Fees
May 3, 2010 After May 3, 2010
r SPS Physician Member . ...................................................................$450 ..........................................................................$500
r SPS Allied Health Member ................................................................$375...........................................................................$425
r SPS Nurse/Nurse Practitioner Member* ...........................................$375 ..........................................................................$425
r SPS Trainee/Student Member . .........................................................$50 ............................................................................$100
r Physician Non-Member .....................................................................$550 ..........................................................................$600
r Nurse/Nurse Practitioner Non-Member* . ..........................................$425 ..........................................................................$475
r Allied Health Non-Member.................................................................$425 ..........................................................................$475
r Trainee/Student Non-Member ...........................................................$70 ............................................................................$120
r Gold/Silver Institutional Physician .....................................................$450 ..........................................................................$500
r Gold/Silver Institutional Allied Health . ...............................................$375 ..........................................................................$425
r Gold/Silver Institutional Nurse/Nurse Practitioner .............................$375 ..........................................................................$425
r Gold/Silver Institutional Trainee/Student ...........................................$50.............................................................................$100
r 2010 SPS Conference Speaker ........................................................n/c..............................................................................n/c
r I plan to attend the Welcome Reception.............................................Free............................................................................Free
r Accompanying Guest (For Welcome Reception only)........................$50.............................................................................$75
Guest Name ____________________________________________
r Sunday, May 23, 2010 Sedation Provider Course..............................$250...........................................................................$300
Held at Kosair Children’s Hospital. Space is limited to 24 registrants. Registration for the main course is not required to attend this course.
TOTAL AMOUNT DUE $ ____________
* Nurses must provide license information: # ____________________________________________ State ________________
Breakouts (Choose Four):
r 1. The Business of Sedation
r 2. Using Sedation for Ultrasound
Procedures
r 3. Sedation-Based Research
r 4. Choosing the Ideal Sedation Agent
r 5. Competencies and Credentialing in Sedation
r 6. Non-pharmacological Sedation Based
Adjuncts
r 7. Practicing Family Centered Care
in Sedation
r 8. The Emergent Sedation Request
Payment Information:
r Check (payable to SPS) r Discover
r MasterCard
r Visa
Card Number:________________________________________________________________Expiration Date: Month_____Year_____
Printed Name on Card: ________________________________________ Signature:_________________________________________
Refund Policy: An 80% Refund will be given through May 3, 2010. After May 3, there will be no refunds. Refund will be determined
by date written cancellation is received.
How did you hear about the meeting?
r Website
r Printed Program
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r Word of Mouth
r Postcard
r Other
The Society for Pediatric Sedation
Membership Application
The Society is open to all healthcare providers who are actively involved in the delivery of pediatric sedation and all those who
wish to advance the society’s mission. Individuals who express an interest in pediatric sedation via clinical practice, research and/
or education may be a member of the Society for Pediatric Sedation.
First Name:______________________ Last Name:_ ________________________ Title:_______________
Birth Date:___________________ Specialty:________________________________________________
Affiliation:__________________________________________________________________________
Address:___________________________________________________________________________
City:______________________________________________________________________________
State/Province:_ ______________Country:_________________________ Postal Code:_ _______________
Work Phone:______________________________Home Phone:_________________________________
Fax:_____________________________E-mail:_____________________________________________
Membership Category
r
Founders Circle (NEW): Any healthcare provider who meets the physician or allied health categories may join by paying the fee
established by the Board of Directors. Membership in this category provides the member with special recognition and privilege as
determined by the Board of Directors.
$200
r
r
r
r
Physician: Licensed physicians with an interest in pediatric sedation may become a member.
$100
Allied Health/RN: Any licensed healthcare provider who is not a physician may become a member.
$50
Allied Health/Other: Any licensed healthcare provider who is not a physician may become a member.
$50
Associate (NEW): Anyone with an interest in the field of pediatric sedation who does not meet the criteria of any other category may
become an associate member. Associate members are not eligible to vote or hold office.
$50
r
Trainee (NEW): Any student, resident or healthcare provider involved in a training program may become a member.
Trainee Institution:________________________________________________________________________________
Location:_ _________________________________________Graduation/Residency Date:_ ________________________
$20
Payment Options:
r Check or Money Order Enclosed (US Funds) Made Payable to the Society for Pediatric Sedation
r Mastercard r Visa r Discover Expiration Date:_______________________________________
Card Number:____________________________________________________________________
Printed Name on Card:______________________________________________________________
Signature:______________________________________________________ Date:________________
Society for Pediatric Sedation
2209 Dickens Road • Richmond, VA 23230-2005 • (804) 565-6354 • Fax (804) 282-0090 • Email: sps@societyhq.com
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