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)

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