Emergency Department Guideline. Procedural Sedation and Analgesia Policy for the Registered Nurse

Transcription

1 Emergency Department Guideline Purpose: To ensure safe, consistent patient monitoring and documentation standards when procedure related sedation and analgesia is indicated. Definitions: Minimal Sedation (anxiolysis): 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. Moderate sedation/analgesia ( 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. Cardiovascular function is usually maintained. Deep Sedation/analgesia: A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. Anesthesia: Consists of general anesthesia and major regional anesthesia. It does not include local anesthesia. General Anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. Pre Sedation: Informed Consent Complete NPO Status Confirmed IV Access Established Emergency Equipment at Bedside o Airway Cart ~ 1 ~

2 o Suction o Pulse Ox/Capnography Equipment o Reversal Medications o Ekg Monitoring, Continuous BP monitoring o Supplemental Oxygen Time Out: Correct Patient Correct Site Correct Side Correct Procedure Consent Verified Monitoring During Procedure RN will continuously monitor heart rate and oxygenation by audible pulse oximetry. RN will monitor respiratory frequency and adequacy of pulmonary ventilation Document Vital Signs every 5 minutes; minimally Heart Rate, Respiratory Rate, O2 saturation, Blood Pressure, ETCO2, and (EKG rhythm if indicated) Vital Signs should additionally be recorded after every medication administration and with any significant event Document Assessment of pain, Sedation Level, Aldrete Score with vital signs q 5 minutes EKG is monitored in all patients (may wait to place leads on patients after first dose of medication is administered in those too young to tolerate) Post Procedure RN is to remain with patient until back to baseline For deep sedation, continuously monitor heart rate and oxygenation, respiratory rate, blood pressure, ETCO2, and (if indicated EKG rhythm) every 15 minutes For moderate sedation, monitoring minimally every 30 minutes Minimum recovery time one hour post medication or meets established discharge criteria. Minimum of 2 hours post procedure observation and monitoring if reversal agent used. D/C PIV once patient is at baseline Discharge Discharge can occur when the Aldrete Score is at baseline and the patient is able to tolerate PO s RN staff administering sedation will have: No other concurrent responsibilities during the actual procedure Current PALS certification Basic ability to recognize a cardiac dysrhythymia for monitoring purposes ~ 2 ~

3 Working knowledge of sedatives/analgesics/and antagonists Completed education for sedation and analgesia Completed additional education and competency verification to assist physician with deep sedation Ongoing education in care of pediatric sedation patients Sufficient numbers of personnel must be present when performing sedation in addition to the Staff Physician credentialed to perform Procedural Sedation. 2 RN s must be present to properly administer medication and assist with procedure and safely monitor patient ~ 3 ~

4 The Modified Aldrete Score Activity Score Able to move four extremities voluntarily or on command 2 Able to move two extremities voluntarily or on command 1 Unable to move extremities voluntarily or on command 0 Respiratory Able to breathe deeply and cough freely 2 Dyspnea or limited breathing 1 Apneic 0 Circulation BP + 20% of preanesthetic level 2 BP % of preanesthetic level 1 BP + 50% of preanesthetic level 0 Consciousness Fully awake 2 Arousable on calling 1 ~ 4 ~

5 Not responsive 0 O2 Saturation Able to maintain O2 saturation >92% on room air 2 Needs O2 to maintain O2 saturation >90% 1 O2 saturation <90% even with O2 supplement 0 Total Patients with scores of 8-10 may be transferred to the next phase of recovery. ~ 5 ~