Transcript Sedation Competency Annual Review

Sedation
Exclusions from the policy
Patients receiving a single oral medication in
standard outpatient dose
Patients undergoing minimal sedation. Defined by
policy as “one drug, one route, one dose, one
time”
Intubated patients in acute care areas who will be
mechanically ventilated during and after the
procedure
Patients having surgery or other procedures under
the care of anesthesia practitioners
Anxiolysis
(minimal sedation)
A drug-induced state during which patients respond
normally to verbal commands. Although cognitive
function and coordination may be impaired, ventilatory
and cardiovascular functions are unaffected.
Applies when medication is given prior to a procedure
for the purpose of lessening anxiety.
The ability to rescue the patient from unintended
deeper sedation must be present
Moderate
(Conscious)
Sedation
A drug induced depression of consciousness
during which patients respond purposefully to
verbal commands, either alone or accompanied
by light tactile stimulation. No interventions
are required to maintain a patent airway, and
spontaneous ventilation is adequate.
A nurse monitoring the patient can perform
brief interruptible tasks to assist the physician.
Deep Sedation
A drug induced depression of consciousness
during which patients cannot be easily aroused but
respond purposefully after repeated or painful
stimulation. The ability to maintain ventilatory
function may be impaired.
The nurse monitoring the patient may not perform
tasks other than those related to the administration
of sedation.
Equipment Requirements
Crash cart (or appropriate components) with
defibrillator
Reversal medications
Oxygen and Suction
Pulse oximeter and automated B/P monitor
Pre-sedation Assessment Requirements
Evidence of informed consent inclusive of the risks,
benefits and alternatives for sedation and procedure
NPO status
Weight and age
Appropriate History and physical
Intended level of sedation
Diagnosis / Indication for the procedure / sedation
Allergies or prior drug reactions
Current medications
Current health problems
VS prior to sedation
ASA Classification
Requirements for Patient care during
sedation
Physician with appropriate privileges should be
immediately available
Patent vascular access
Continuous HR and O2 sat. monitoring
B/P, RR documented q 15 min (moderate
sedation), q 5 min. (deep sedation)
Documentation of the start and stop time of the
procedure
Level of sedation (Modified Riker Scale)
Post procedure Aldrete Score
Modified Riker Scale
0= Awake, calm, follows commands
-1= Drowsy; will respond to verbal stimuli
-2= Arouses to noxious stimuli only
-3 Unarousable to any stimuli
Requirements for patient care
post sedation
B/P, HR, RR, saturation and aldrete score
every 15 minutes until recovered
Successful completion of a measurable
criteria to discharge from procedure to the
recovery phase (Aldrete Score)
Aldrete Scoring
Color
LOC
Circulation
Activity
Total:
2= pink, 1= pale,
0=cyanotic
2= fully awake,
1=arousable,
0= Not responding
2 =B/P +/- 20%
presedation value
1= B/P +/- 20-50%
presedation value
0= B/P +/- 50% of
presedation value
2= able to move 4
extremities,
1= able to move 2
ext,
0=able to move 0
extremeties
Pre
Post
Confirming Physician Privileges
Start using the UCLA Mednet
Homepage
Click on “QMS- Center for
Patient Safety and Quality”
Click on “Clinical Privileges”
Enter Physician name
Delineated privileges appear for
each physician