Forms ensure consistency of conscious sedation
How can you ensure consistency in administration and monitoring of conscious sedation in different settings in your facility? Try using one form for documentation, your peers suggest. The purpose of such a form is to avoid problems when conscious sedation is administered in different areas or by non-anesthesiologists.
"For people who routinely work with conscious sedation, we had no negative outcomes," says Sandra Hilliker, RN, MSN, nurse manager for perianesthesia at Fairview Southdale Hospital in Edina, MN. "But there was a concern throughout the rest of the hospital that with physicians and nurses less familiar with conscious sedation, there could be the potential for problems."
The Task Force of Sedation and Analgesia by Non-Anesthesiologists, part of the Park Ridge, IL-based American Society of Anesthesiologists, recommends documentation. Specifically, the task force says: "Patients’ ventilatory and oxygenation status and hemodynamic variables should be recorded at a frequency to be determined by the type and amount of medication administered, as well as the length of the procedure and the general condition of the patient. At a minimum, this should be: (1) before the beginning of the procedure, (2) after administration of sedative/analgesic agents, (3) on completion of the procedure, (4) during initial recovery, and (5) at the time of discharge. If recording is performed automatically, device alarms should be set to alert the care team to critical changes in patient status."1
"The importance of this is that documentation can help with diagnosis of any complications that might occur later, and medical/legal issues are protected this way," says Isaac Azar, MD, vice chairman of department of anesthesiology at Beth Israel Medical Center and professor of anesthesiology at Albert Einstein College of Medicine, both in New York City.
Leaders at Westchester County Medical Center in Valhalla, NY, decided a preprocedure assessment form would ensure consistency of conscious sedation across department settings. (See insert.) They wanted to avoid duplicating information that already was being documented and limit the form to one piece of paper. It was designed to ensure that providers are obtaining full preoperative assessments, including allergy history, NPO status, past experiences with sedation, and medication that could interfere with sedatives.
At Fairview Southdale Hospital, the conscious sedation clinical pathway puts allergies in a conspicuous position in the upper right-hand corner. (See pathway insert.) The patient’s medical history also is featured prominently. The history and physical may have been dictated by the physician, Hilliker points out. "We felt it was important for the nurse doing the assessment and the procedure to have this information," she says. "You may need to adjust your plan of care based on the patient’s past medical history of cardiac disease. You may want to use a heart monitor."
Also, current medications and dosages are listed at the top. "A lot of times, patients say, I don’t have any heart disease,’ but they’re on lanoxin," a form of digitalis, she says. The form, which shows Fairview’s move toward an outcome-based practice, is divided into pre-procedure, intraprocedure, and discharge/post-procedure because different nurses may be involved in each aspect of care,.
Pathway specifies outcomes, interventions
For each area, expected outcomes are spelled out, along with interventions that will enable patients to meet those outcomes. For example, in the discharge/post-procedure area of the form, for a patient to be able to verbalize understanding of discharge instructions (outcomes), written discharge instructions are reviewed with the patient and a responsible adult (intervention). The interventions include documentation of vital signs and mental status — "all the interventions that help the patient have a stable physiological outcome at the end of the procedure," Hilliker says.The second page of the record includes room for more extensive monitoring and documentation.
Reference
1. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non- anesthesiologists. Anesthesiology 1996; 84:463.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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