University of Kentucky / UK HealthCare Policy and Procedure

Size: px
Start display at page:

Download "University of Kentucky / UK HealthCare Policy and Procedure"

Transcription

1 University of Kentucky / UK HealthCare Policy and Procedure Policy # A Title/Description: Sedation for Procedures Purpose: To provide guidelines for providers administering and monitoring sedation during procedures Policy Definitions Procedure Differences between Moderate Sedation and Deep Sedation Techniques Pre-Procedure Assessment and Plan Consultation in Special Situations Consent for Procedures and Sedation Pre-Procedure Fasting Guidelines Pre-Procedure Communication between Practitioners Intravenous Access Immediate Pre-Procedure Assessment Administration of Medications Minimum Staffing for Sedation Competency of Clinical Staff Emergency Equipment for Sedation and Analgesia Monitoring Requirements Documentation Intra-Procedure Monitoring Post-Procedure Monitoring Post-Procedure Monitoring after Light Sedation Documentation Requirements Criteria for Transfer or Discharge Discharge from the Facility Discharge Instructions for Outpatients Persons and Sites Affected Policies Replaced Effective Date Review/Revision Dates Appendix 1 Post Procedure Scoring System Appendix 2 Post Procedure Outpatient Scoring System Appendix 3: Medication Guidelines for Sedation 1-Reversal agent dosing and use Policy Sedation and analgesia comprise a continuum of medically induced states of consciousness ranging from minimal sedation through general anesthesia. Sedation may be administered by Policy # A Sedation for Procedures 1

2 various routes. When administered for the performance of diagnostic or therapeutic procedures, sedation may produce loss of protective reflexes. Consistent with evidence-based practice of medicine, health care providers shall follow the guidelines described in this policy in the administration and monitoring of sedation and analgesics. This policy applies to all age groups of patients requiring moderate or deep sedation for diagnostic or therapeutic procedures. This policy does not apply to: 1. Patients receiving local or topical anesthesia; 2. Patients receiving a single sedative or analgesic medication administered in doses appropriate for unsupervised treatment of insomnia, anxiety, or pain; 3. Patients receiving therapeutic management of seizures; 4. Patients being maintained on mechanical ventilation as part of a treatment protocol; 5. Patients receiving less than 50% nitrous oxide in oxygen with no other sedative or analgesic medication by any route; 6. Patients receiving light sedation; 7. Patients receiving peripheral nerve blocks; or 8. Patients receiving general or major conduction anesthesia (for example, spinal or epidural/caudal block). These guidelines are systematically developed recommendations to assist with the provision of safe patient care. They are not intended to be standards or absolute requirements, and cannot guarantee any specific outcome. They may be modified by a physician member of the medical staff according to special clinical needs or constraints. These guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. See, Summary Report of Kentucky Board of Nursing Advisory Opinions on Nursing Practice Issues, July 1, 2008-June 30, Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Practitioners intending to produce a given level of sedation must have the skills to be able to rescue patients whose level of sedation becomes deeper than initially intended. Individuals administering moderate sedation or analgesia must be able to rescue patients who enter a state of deep sedation/analgesia, while those administering deep sedation/analgesia must be able to rescue patients who enter a state of general anesthesia. Definitions This policy uses the definitions of levels of sedation and analgesia published by the American Society of Anesthesiologists (ASA) in its Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Light or minimal sedation (anxiolysis) is 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) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or Policy # A Sedation for Procedures 2

3 accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Moderate sedation is usually inadequate in children to achieve the level of sedation necessary to perform procedures. Deep sedation/analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused, but respond purposefully following repeated or painful stimulation. The ability to maintain ventilatory function independently may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to maintain ventilatory function independently 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. Procedure Differences between Moderate Sedation and Deep Sedation Techniques Moderate Sedation Deep Sedation Depressed level of consciousness More significantly depressed level of consciousness Follows commands Unable to follow commands consistently Protective reflexes expected to be maintained Protective reflexes can be affected Vital signs expected to remain stable Vital signs may be labile Short post-procedure stay Occasional prolonged post-procedure monitoring Infrequent sedation-related complications More frequent sedation-related complications Less effective with uncooperative patients May be useful in providing care to uncooperative patients Pre-Procedure Assessment and Plan Pre-procedure assessment shall be performed and recorded before beginning sedation. The assessment shall include medical history, including response to previous sedation and anesthesia, physical examination of the heart, airway, and lungs, diagnosis, psychosocial assessment, weight, vital signs, and plan. The written pre-procedure assessment shall be complete and present in the medical record before the procedure begins. Medical history, physical examination, and plan must be completed by a physician or Licensed Independent Practitioner (LIP). See, Pre-Anesthesia Screening Evaluation by ARNPs and/or RNs 1. Appropriate medical history includes response to previous sedation and anesthesia. Aspects of the patient s medical history may alter the patient s response to sedation/analgesia. These include: (a) Abnormalities of the major organ systems; (b) Previous adverse experiences with sedation/analgesia as well as regional and general anesthesia by the patient or family members; Policy # A Sedation for Procedures 3

4 (c) History of allergies, regular medications and last dose, specific drugs taken within the 24 hours immediately preceding the procedure, including prescription drugs, overthe-counter medications and dietary supplements, herbal supplements, and illicit drugs, and potential drug interactions; (d) Time and nature of last oral intake; and (e) History of tobacco use, alcohol use, or substance abuse. 2. Appropriate airway history includes a review of: (a) Previous problems with anesthesia or sedation; (b) Stridor, snoring, or sleep apnea; (c) Advanced rheumatoid arthritis; (d) Chromosomal abnormality (for example, trisomy 21); and (e) Inability to lie flat. 3. The physical examination shall include an examination of the heart, airway, and lungs, and shall be completed within the 24 hour period before the procedure. Positive pressure ventilation by mask, with or without tracheal intubation, may be necessary if respiratory compromise develops during sedation/analgesia. This may be more difficult in patients with atypical airway anatomy. Also, some airway abnormalities may increase the likelihood of obstruction during spontaneous ventilation. Some factors which may be associated with difficult airway management are: (a) Habitus: Significant obesity (especially involving the neck and facial structures); (b) Head and neck: Short, thick neck, limited neck extension, decreased hyoid-mental distance (<6cm in an adult), neck mass, cervical spine disease or trauma, tracheal deviation, dysmorphic facial features (for example, Pierre-Robin syndrome), beard, and nasogastric tube; (c) Mouth: Small opening (<3cm in an adult), edentulous (mask ventilation more difficult, intubation easier), protruding incisors, loose or capped teeth, dental appliances, high, arched palate, macroglossia, tonsillar hypertrophy, non-visible uvula; (d) Jaw: Micrognathia, retrognathia, trismus, significant malocclusion; and (e) Inability to cover upper lip with lower incisors. 4. An appropriate psycho-social assessment shall include: (a) Pre-procedure teaching needs; (b) For outpatients: a planned method of transport from the hospital or outpatient facility, presence of a responsible adult to provide post-discharge care, and an understanding of the procedure to be performed; and (c) Demonstration by the patient or responsible adult accompanying the patient of his/her understanding of discharge instructions (a copy of discharge instructions will be placed in the medical record). Policy # A Sedation for Procedures 4

5 5. Weight and vital signs to be recorded include: (a) Patient s weight in kilograms; (b) Patient s height; and (c) Baseline data, including heart rate, blood pressure, respiratory rate, oxygen saturation, level of consciousness, comfort level, and pre-procedure transfer/discharge score. 6. The patient s sedation plan, as determined by the physician, includes: (a) Procedure to be performed; (b) Agents to be used for sedation; (c) Assignment of ASA physical status classification: ASA1 A normal healthy patient ASA2 - A patient with mild systemic disease ASA3 A patient with severe systemic disease ASA4 A patient with severe systemic disease that is a constant threat to life ASA5 A moribund patient who is not expected to survive with or without the procedure ASA6 A declared brain-dead patient whose organs are being removed for donor purposes Consultation in Special Situations For patients with significant underlying medical conditions (for example, extremes of age, severe cardiac, pulmonary, hepatic, or renal disease, pregnancy, drug or alcohol abuse), pre-procedure consultation with an intensivist, an emergency medicine attending physician 1 or anesthesiologist shall be obtained. For patients with significant sedation-related risk factors (for example, uncooperative patients, morbid obesity, potentially difficult airway or sleep apnea), pre-procedure consultation with an intensivist, an emergency medicine attending physician 1 or anesthesiologist shall be obtained. For severely compromised or medically unstable patients (for example, anticipated difficult airway, severe obstructive pulmonary disease, coronary artery disease, or congestive heart failure), or if it is likely that sedation to the point of unresponsiveness will be necessary to obtain adequate conditions, practitioners who are not trained in the administration of general anesthesia shall consult an Intensivist, an emergency medicine attending physician 1 or anesthesiologist. Consent for Procedures and Sedation Procedure and sedation risks, benefits, and alternatives shall be discussed with the patient and if possible the patient s family, and signed consent shall be obtained. See, UK HealthCare Policy A06-000, Consent to Treatment. 1 Emergency medicine attending physicians provide consultations only in the Emergency Department. Policy # A Sedation for Procedures 5

6 Pre-Procedure Fasting Guidelines Healthy patients shall be required to fast prior to planned sedation for elective procedures according to the following guidelines. If the patient fails to fast according to these guidelines and pre-procedure instructions, the procedure will either be delayed or rescheduled. Ingested Material Clear liquids Breast milk Infant formula Non-human milk Light meal Regular meal Minimum Fasting Period 2 hours* 4 hours* 6 hours* 6 hours* 6 hours* 8 hours* *without conditions that may prolong gastric emptying or impair function of esophagogastric juncture. These recommendations apply to healthy patients who undergo elective procedures. They are not intended for women in labor or patients undergoing emergency, time-sensitive procedures. Following the guidelines does not guarantee complete gastric emptying has occurred. Fasting periods apply to all ages. Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. Since non-human milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period. A light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong gastric emptying time. Both the amount and type of foods ingested and risk factors for delayed gastric emptying (for example, diabetes, pregnancy, and obesity) should be considered when determining an appropriate fasting period. Pre-Procedure Communication between Practitioners The purpose of the medical record is to facilitate communication between practitioners. For inpatients that are being sent from their nursing unit for a procedure in another area, the inpatient medical record, including nursing records of vital signs, and the current medication administration record, shall be available in the procedure area. The pre-operative nursing checklist, when required, shall also accompany the patient. An appropriate handoff report (or e- handoff) shall be given before the patient is transferred to the procedure area. See, UK HealthCare Policy A08-030, Hand-off Communications. Intravenous Access Vascular access shall be maintained throughout the procedure and the post-sedation recovery period. For patients who have received sedation by non-intravenous routes, or whose intravenous line has become dislodged or blocked, practitioners should determine the advisability of establishing or reestablishing intravenous routes on a case-by-case basis. In all instances, an individual with the skills to establish intravenous access must be immediately available. See, Kentucky Board of Nursing Advisory Opinion Statement: Administration of Medications for Sedation by Nurses. Policy # A Sedation for Procedures 6

7 Immediate Pre-Procedure Assessment The patient shall be reevaluated by the practitioner who will administer the sedation immediately before moderate or deep sedation induction in accordance with the universal protocol, including performance of a time-out. Evaluation must include vital signs. See Policy A08-015, Universal Protocol. Administration of Medications Sedation medications may be administered by a physician, dentist, advanced registered nurse practitioner, or registered nurse subject to the scope of practice, training, and privileging of such practitioner. Medications shall be administered in small incremental doses that are titrated to the desired endpoints of sedation. Sufficient time must elapse between doses to allow the effect of each dose to be evaluated before subsequent doses are administered. Specific antagonists shall be immediately available whenever opioid analgesics (for example, naloxone) or benzodiazepines (for example, flumazenil) are administered. Following pharmacological reversal, patients shall be observed for a minimum of two hours to ensure that sedation and cardio-respiratory depression do not recur after the effect of the antagonist dissipates. The use of sedation regimens that include the routine use of reversal agents is discouraged, because there is insufficient evidence to support this practice. Unless supervised and monitored by competent medical and/or nursing staff, the patient shall not be sedated before being transported to a procedural area. Minimum Staffing for Sedation For moderate sedation, a competent provider, other than the person performing the procedure, shall be present to monitor the patient throughout the procedure. This individual s only responsibility shall be to monitor the patient. If the procedure requires assistance, this individual may assist other practitioners with minor or interruptible tasks. For deep sedation, the provider shall be prepared to rescue the patient. This implies the ability to manage airways and respond to significant changes in vital signs. The individual monitoring the patient may not assist in other tasks. Competency of Clinical Staff Medical staff and nursing staff shall demonstrate competency to perform activities for which responsibility is assumed. For sedation, medical and nursing staff shall demonstrate competency to manage a compromised airway, hypoventilation, respiratory instability and cardiovascular instability. Other requirements include, but are not limited to: 1. Familiarity with the effects and side effects of each sedation agent used; 2. Ability to recognize and correct airway compromise; 3. Ability to recognize abnormalities in the required parameters; 4. Ability to implement appropriate interventions; and Policy # A Sedation for Procedures 7

8 5. Ability to manage ventilation using a bag valve mask device and manage advanced airway management, and provide basic life support (BCLS) and access personnel immediately with current status in advanced cardiopulmonary life support (ACLS, NRP, and/or PALS). All medical and nursing staff involved in sedation shall have initial education in monitoring sedated patients and appropriate administration of medications. An annual competency evaluation is required for those who participate in sedation monitoring that shall be documented in the person s personnel file. Emergency Equipment for Sedation and Analgesia The following equipment and supplies appropriate to the age and size of the patient shall be immediately available whenever sedative or analgesic drugs capable of causing cardio respiratory depression are administered. 1. Cardiac monitor; 2. Pulse oximeter; 3. Oxygen, including equipment for administration; 4. Bag/valve/mask airways; 5. Oral and nasal airways; 6. Intubation kit; 7. Intravenous supplies; 8. Emergency cart; 9. Defibrillation equipment; 10. Pharmacologic reversal agents; 11. Suction apparatus and supplies; 12. Blood pressure monitor; 13. Thermometer; and 14. Sedation medications and rescue medications. Monitoring Requirements 1. Moderate sedation may be monitored per unit guidelines, as long as they meet or exceed the following requirements: (a) Continuous oxygen saturation; (b) Ventilatory function (tidal volume or respiratory rate); (c) Heart rate; (d) Blood pressure; (e) Respiratory rate; (f) Level of consciousness and purposeful response to stimuli; Policy # A Sedation for Procedures 8

9 (g) Cardiac rhythm, if patient has cardiac or pulmonary disease; and (h) Continuous capnography See also Standards for Basic Anesthetic Monitoring 2011 Sedation/analgesia scale 2. Deep Sedation monitoring must include all of the above and: (a) Cardiac rhythm via electrocardiography; continuous electrocardiography monitoring may be discontinued during the procedure if it interferes with the performance of the procedure (for example, MRI); (b) Temperature (if procedure is expected to last longer than one hour, should be taken every hour as long as interfere with the procedure); and (c) Continuous capnography. Documentation Monitoring variables are to be recorded on the appropriate record before initiating sedation, during the procedure, during recovery, and immediately before discharge. Intra-Procedure Monitoring Intra-procedure monitoring shall begin with initiation of sedation. Frequency of monitoring shall be continuous and individualized. Monitoring variables shall be documented at least every five minutes or more frequently, if appropriate based on the patient s condition. Post-Procedure Monitoring There shall be ready access to an appropriately privileged physician who is available to evaluate and resuscitate the patient during the post-procedure period. The physician s name and pager number shall be readily available during the post-procedure period. The patient shall be observed in an appropriately staffed and equipped area until the patient is near his or her baseline level of consciousness and is no longer at an increased risk for cardio respiratory depression. Post-procedure monitoring shall continue until the patient is determined to be ready for transfer or discharge based on the appropriate post-procedure scoring system. Typically, monitoring shall continue for at least 30 minutes for moderate sedation and 60 minutes for deep sedation after the last sedating agent was administered. Oxygenation shall be monitored continuously until the patient is no longer at risk for hypoxemia. Ventilation and circulation shall be monitored at regular intervals until the patient is suitable for discharge. Following pharmacological reversal of sedation/analgesia, the patient shall be observed for a sufficient time based on the applicable post-procedure scoring system to verify that sedation or cardio respiratory depression does not recur once the effect of the antagonist dissipates. Pre-term Infants less than 60 weeks of post-conceptual age, and full-term infants less than 50 weeks post conceptual age; who have received any sedative agents; shall be observed in a monitored environment. These children shall be free of apnea or bradycardia for at least 12 hours post sedation before being discharged from the monitored environment. Infants with severe chronic disease may have central or obstructive apnea and should also be monitored as above. Documentation of continuous pulse oximetry, heart rate, ventilatory function, respiratory rate, blood pressure, level of consciousness, and sedation/comfort level shall occur every five minutes Policy # A Sedation for Procedures 9

10 four times, and then every 15 minutes until the patient returns to the pre-procedure baseline. The patient must meet discharge or transfer criteria. Monitoring shall continue post-sedation until discharge or transfer criteria are met. If the patient needs to be transported to another area before he/she is completely recovered, the patient shall be accompanied by licensed staff with the ability to continue the post-procedure monitoring. Post-Procedure Monitoring after Light Sedation The patient shall be observed in an appropriately staffed and equipped area until he or she is no longer at risk for respiratory depression. Documentation of pulse oximetry, heart rate, respiratory rate, blood pressure, and level of consciousness shall occur immediately after administration of medication. Monitoring of respiratory status shall continue for at least 30 minutes after the last medication was administered. Respiratory assessment shall include rate, rhythm, and depth. After 30 minutes of monitoring a patient may be discharged if his or her vital signs and general condition are stable. (Refer below for discharge considerations). Documentation Requirements The following information must be documented in the medical record: 1. Pre-procedure assessment as described in this policy; 2. Consent process as described in this policy; 3. Physiologic data from established monitoring standards and at any significant event; 4. Dosage, route, time and effect of sedative medications; 5. Interventions and patient response; 6. Untoward or significant reactions and resolutions; 7. Transfer or discharge criteria met; 8. A responsible adult is present to accompany the patient from the hospital or outpatient facility; and 9. Signed discharge instructions, if outpatient procedure. Criteria for Transfer or Discharge The patient s readiness for transfer or discharge is determined utilizing scoring systems that assess the patient s post sedation alertness, physiological stability, and comfort. See Policy OR08-05 Discharge Criteria for PACU, Phase I and Phase II. If the patient is being transferred to another unit within the facility: 1. The registered nurse shall complete the Post Procedural Scoring system. A copy of this document is attached to this policy. This scoring system is used to determine if the patient has reached acceptable limits or has returned to his/her baseline after sedation and before transfer. 2. Only after 30 minutes post-procedure monitoring for moderate sedation or 60 minutes for deep sedation, and the recording of a post procedure score greater than or equal to 12, and Policy # A Sedation for Procedures 10

11 the meeting of any special procedural criteria determined by the attending physician; may a patient be transferred to a general care area from the procedural area. 3. If (a) only propofol or nitrous oxide, and no other sedative/analgesic drug, was used during deep sedation, and (b) if other criteria have been met, including the recording of a post procedure score greater than or equal to 12 and any special procedural criteria determined by the attending physician, then post- procedural observation may be discontinued after 15 minutes. 4. Sufficient time needs to have elapsed after the last administration of reversal agents (for example, naloxone, flumazenil) to verify that the patient does not become re-sedated after reversal effects dissipate based on the applicable discharge or transfer scoring system. 5. An appropriate handoff report shall be given to the individual assuming care of the patient. If transported by nonlicensed personnel, appropriate information about the patient shall be given to the transporter using a standardized format, such as the Ticket to Ride. Discharge from the Facility The post sedation outpatient scoring system shall be used in a procedural area or emergency department, when a patient is being discharged post procedure from the facility. A copy of this document is attached to this policy. This scoring system is used to determine whether the patient has returned to baseline and/or acceptable ranges. In addition to intra-facility transfer criteria, the following criteria shall be met: 1. Psychosocial status has been ascertained and documented, including a planned method of transport and an understanding of the procedure. 2. There is a physician s order for discharge and there is documentation that the patient meets discharge criteria. 3. A responsible adult is present to accompany the patient from the hospital; if no responsible adult is present to accompany the patient, the patient must be monitored for eight hours post-procedure or longer if pre-procedure level of consciousness has not been attained. The patient shall not drive home, but shall be driven by a responsible adult. The patient shall be instructed not drive for 24 hours. For purposes of this policy, a responsible adult is at least 18 years old. Discharge Instructions for Outpatients Patients shall receive discharge instructions prior to sedation, if possible. Written discharge instructions shall be given to the patient and/or the responsible adult accompanying the patient. These instructions and any additional instructions will be reinforced before discharge. The patient or the responsible adult shall sign the written discharge instructions to acknowledge understanding. A copy of the signed discharge instructions shall be retained for the medical record. Written discharge instructions shall include information regarding sedation and the procedure. The instructions shall include: 1. Restrictions to diet, including no use of alcohol; Policy # A Sedation for Procedures 11

12 2. Restrictions to activity, including driving and operation of machinery, positioning in car seat; 3. Use of prescribed medications; 4. Signs and symptoms of complications; 5. Conditions which require a physician be called; and 6. Instructions on contacting a physician for post-procedure problems, including the name and day/after-hours telephone numbers. Caregivers assuming responsibility for pediatric patients post-discharge shall be instructed regarding the risk of airway obstruction if the head falls forward while the child is secured in the car seat and proper positioning. It is advisable for another adult or the emancipated minor s parent (in addition to the responsible adult driver) to accompany a child being transported by car. Persons and Sites Affected Enterprise Chandler Good Samaritan Kentucky Children s Ambulatory Department Policies Replaced Chandler HP08-20 Good Samaritan Col016, Col124 Kentucky Children s CH Ambulatory KC Other Effective Date: 6/2010 Review/Revision Dates: 7/2008, 11/16/12 Approval by and date: Signature Name Arundathi M. Reddy and Mary Bauer, Review Team Co-Leader(s) Signature Name Anna L. Smith, Chief Administrative Officer Signature Name Michael Karpf, Executive Vice President for Health Affairs Date Date Date Policy # A Sedation for Procedures 12

13 Appendix 1 Post Procedure Scoring System Policy # A Sedation for Procedures 13

14 Appendix 2 Post Procedure Outpatient Scoring System Policy # A Sedation for Procedures 14

15 Appendix 3: Medication Guidelines for Sedation Drugs Generic (Brand) Initial Dose (Adult) Initial Dose (Pediatric) Sedatives Lorazepam (Ativan) 1-2 mg IV mg/kg IV Midazolam (Versed) 1-2 mg IV mg/kg IV Analgesics Fentanyl mcg IV mcg/kg Hydromorphone (Dilaudid) Ketamine (Ketalar) mg IV mg/kg IV 1-2 mg/kg IV mg/kg IV 2-5 mg/kg IM Increment/ Recommended Maximum One- Time Dose Same as initial dose Q10 mins Max: 4 mg Same as initial dose Q2-3 mins Max: 10mg Same as initial dose Q5-10mins mg/kg Q20mins IV: mg/kg q10min IM: 2-4 mg/kg q15mins Onset/Peak/ Duration (minutes) Adverse Effects Reversal Agent 1 Onset: 5/ Peak:15/ Duration: 4-8hrs Onset:1-3/ Peak:5/ Duration: Onset:1-2/ Peak:3-5/ Duration:30-60 Onset:5-10/ Peak: 20/ Duration: 2-3hrs IV: Onset: 30s/ Peak:1-2/ Duration:5-10 IM: Onset: 2-4/ Peak:15/ Duration:15-60 Respiratory depression, hypotension, bradycardia, paradoxical agitation Respiratory depression, hypotension, bradycardia, paradoxical agitation Respiratory depression, chest wall rigidity; laryngospasm; diaphoresis Hypersensitivity, apnea; euphoria; seizures; hyperthermia; cardiac arrest Emergence delirium, tachycardia, salivation, increased BP, laryngospasm, myocardial ischemia, increased ICP, increased intraocular pressure Flumazenil (Romazicon) Flumazenil (Romazicon) Naloxone (Narcan) Naloxone (Narcan) None Policy # A Sedation for Procedures 15

16 Drugs Generic (Brand) Initial Dose (Adult) Initial Dose (Pediatric) Morphine 1-4 mg IV mg/kg Hypnotics Etomidate (Amidate) 0.1 mg/kg 0.1 mg/kg Propofol (Diprivan) 1-2 mg/kg 1-2 mg/kg Increment/ Recommended Maximum One- Time Dose mg/kg IV Q5-15mins Max: 15mg 1-2 mg Q10mins Same as initial dose Q5mins Onset/Peak/ Duration (minutes) Adverse Effects Reversal Agent 1 Onset:5/ Peak:20/ Duration:2-4hrs Onset: 1/ Peak: 1/ Duration:5-15 Onset:1/ Peak: 2/ Duration:5-10 Histamine release/ N/V; Sweating; flushing; tremors; hot flashes Adrenal suppression, seizure-like tremors Pain at injection site, hypotension, bradycardia, apnea, allergy to eggs Naloxone (Narcan) None None Policy # A Sedation for Procedures 16

17 1-Reversal agent dosing and use Agent Generic (Brand) Initial Dose Dosing Interval/Max Dose Adverse Effects Flumazenil (Romazicon) 0.2 mg IV Q1min Max-1 mg Naloxone (Narcan) mg IV Q1min Max-2 mg Seizure activity; dysrhythmias, anxiety; withdrawal (extreme caution in chronic benzo use) Acute pain crisis; dysrhythmias; pulmonary edema; agitation; withdrawal (extreme caution in chronic opiate use) Policy # A Sedation for Procedures 17

Medical Coverage Policy Monitored Anesthesia Care (MAC)

Medical Coverage Policy Monitored Anesthesia Care (MAC) Medical Coverage Policy Monitored Anesthesia Care (MAC) Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2004 Policy Last Updated: 1/8/2013 Prospective review is recommended/required.

More information

Patient Care Services Policy & Procedure Title: No. 8720-0059

Patient Care Services Policy & Procedure Title: No. 8720-0059 Page: 1 of 8 I. SCOPE: This policy applies to Saint Francis Hospital, its employees, medical staff, contractors, patients and visitors regardless of service location or category of patient. This policy

More information

The American Society of Anesthesiologists (ASA) has defined MAC as:

The American Society of Anesthesiologists (ASA) has defined MAC as: Medical Coverage Policy Monitored Anesthesia Care (MAC) sad EFFECTIVE DATE: 09 01 2004 POLICY LAST UPDATED: 11 04 2014 OVERVIEW The intent of this policy is to address anesthesia services for diagnostic

More information

CH CONSCIOUS SEDATION

CH CONSCIOUS SEDATION Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

More information

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice P.O. BOX 2129 Raleigh, NC 27602 (919) 782-3211 FAX (919) 781-9461 Nurse Aide II Registry (919) 782-7499 www.ncbon.com Issue: Administration

More information

*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.

*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response. Analgesia and Moderate Sedation This Nebraska Board of Nursing advisory opinion is issued in accordance with Nebraska Revised Statute (NRS) 71-1,132.11(2). As such, this advisory opinion is for informational

More information

Title/Subject Procedural Sedation and Analgesia Page 1 of 10

Title/Subject Procedural Sedation and Analgesia Page 1 of 10 Policy Procedural Sedation and Analgesia Page 1 of 10 Scope: Providers and nurses (M.D., D.O., D.M.D., D.D.S., A.P.R.N., P.A., R.N.) with appropriate privileges and who have successfully demonstrated adequate

More information

Mississippi Board of Nursing

Mississippi Board of Nursing Mississippi Board of Nursing Regulating Nursing Practice www.msbn.state.ms.us 713 Pear Orchard Road, Suite 300 Ridgeland, MS 39157 Administration and Management of Intravenous (IV) Moderate Sedation POSITION

More information

PHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false.

PHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false. PHSW Procedural Sedation Post-Test Answer Key 1 1. Define Procedural (Conscious) Sedation: A medically controlled state of depressed consciousness where the patient retains the ability to continuously

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,

More information

Administrative Manual

Administrative Manual I. Description Administrative Manual Policy Name Pediatric Sedation Policy For Non- Anesthesiologists Policy Number ADMIN 0212 Date this Version Effective March 1, 2011 Responsible for Content Pediatric

More information

MODEL SEDATION PROTOCOL FOR MODERATE SEDATION AND ANALGESIA PERFORMED BY NON-ANESTHESIA PROVIDERS DURING PROCEDURES

MODEL SEDATION PROTOCOL FOR MODERATE SEDATION AND ANALGESIA PERFORMED BY NON-ANESTHESIA PROVIDERS DURING PROCEDURES MODEL SEDATION PROTOCOL FOR MODERATE SEDATION AND ANALGESIA PERFORMED BY NON-ANESTHESIA PROVIDERS DURING PROCEDURES ON ADULTS AND CHILDREN OLDER THAN 10 YEARS OF AGE. PURPOSE This policy has been established

More information

Conscious Sedation Policy

Conscious Sedation Policy PURPOSE Provide guidelines to ensure safe and consistent process for patient selection, administration, monitoring and discharge care of patients receiving conscious sedation. Conscious sedation refers

More information

SUBJECT: Adult Moderate Sedation by Non-Anesthesia Personnel Policy # EFFECTIVE: May 2013

SUBJECT: Adult Moderate Sedation by Non-Anesthesia Personnel Policy # EFFECTIVE: May 2013 DEPARTMENT: Anesthesia APPROVED BY: Ashok Kewalramani, DO, Medical Director Anesthesia Joseph Liewer, MD, Medical Director ETOPD MEC 5.20.13 Purpose: To provide guidelines for the management of adult patients

More information

Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist

Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist Administrative Policy & Procedure - Jersey Shore University Medical Center Document Number: JM-ADMIN-0004

More information

Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists SPECIAL ARTICLE Anesthesiology 2002; 96:1004 17 2002 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

More information

POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS

POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS **Hospitals must review and revise with legal counsel and ensure compliance with State and federal laws and regulations. ASA intends

More information

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 44 BOARD OF DENTAL EXAMINERS Chapter 12 Anesthesia and Sedation Authority: Health Occupations Article, 4-205 Annotated Code of Maryland.01 Scope.

More information

Guidelines for the Use of Sedation and General Anesthesia by Dentists

Guidelines for the Use of Sedation and General Anesthesia by Dentists Guidelines for the Use of Sedation and General Anesthesia by Dentists I. Introduction The administration of local anesthesia, sedation and general anesthesia is an integral part of dental practice. The

More information

PATIENT CARE STANDARD

PATIENT CARE STANDARD Sutter Medical Center, Sacramento Nursing POLICY STATEMENT: PATIENT CARE STANDARD It is the policy of hospitals within the Sutter Sacramento Region to provide a uniform, safe, and evidence-based standards

More information

MODERATE SEDATION PRIVILEGING

MODERATE SEDATION PRIVILEGING MODERATE SEDATION PRIVILEGING According to the Columbia St. Mary s Hospitals Policy and Procedure #CSM 1102: Moderate Sedation (Conscious), individuals administering Moderate sedation must be qualified

More information

Date Written or Last Revision: Feb 2015. Page 1 of 24

Date Written or Last Revision: Feb 2015. Page 1 of 24 Page 1 of 24. Contents: I. Purpose II. Policy: III. Definitions: A. Minimal Sedation B. Moderate Sedation C. Deep Sedation D. Anesthesia IV. Equipment V. Medication VI. Process/Procedures Moderate vs Deep

More information

TABLE 2 ASA Physical Status Classification

TABLE 2 ASA Physical Status Classification TABLE 2 ASA Physical Status Classification ASA Class I II III IV V Description A normal, healthy patient, without organic, physiologic, or psychiatric disturbances A patient with controlled medical conditions

More information

DEFINITIONS Minimal Sedation: Moderate Sedation/Analgesia: Deep Sedation/Analgesia: Anesthesia:

DEFINITIONS Minimal Sedation:   Moderate Sedation/Analgesia: Deep Sedation/Analgesia: Anesthesia: Policy: Conscious Sedation Owner: CNO, Anesthesia Department, Medical Staff Initiated: 08/2010 Version: 2 Last Approval Date: 8/2012 Reference: S. Smith, D. Duell, B. Martin, Clinical Nursing Skills, Basic

More information

Who Should Participate*

Who Should Participate* earn 25 contact hours! For as little as $49. 95 Announcing: Sedation Clinical Competency Program Finally A practical solution to satisfy formal training, credentialing, and competency-based educational

More information

Corporate Medical Policy

Corporate Medical Policy File Name: anesthesia_services Origination: 8/2007 Last CAP Review: 1/2016 Next CAP Review: 1/2017 Last Review: 1/2016 Corporate Medical Policy Description of Procedure or Service There are three main

More information

UNMH Procedural Sedation Privileges

UNMH Procedural Sedation Privileges o Initial privileges (initial appointment) o Renewal of privileges (reappointment) o Expansion of privileges (modification) All new applicants must meet the following requirements as approved by the UNMH

More information

UNM SRMC MODERATE AND DEEP SEDATION CLINICAL PRIVILEGES.

UNM SRMC MODERATE AND DEEP SEDATION CLINICAL PRIVILEGES. MODERATE DEEP SEDATION CLINICAL [ ] Initial Appointment [ ] Reappointment Instructions For some practitioners, the privilege of PROCEDURAL SEDATION is requested as a non-core privilege The individual requesting

More information

Provider Sedation Education

Provider Sedation Education Provider Sedation Education Purpose: To provide sedation education for IU Health physicians and dentists seeking moderate and deep sedation credentials. Credentialing requirements: Moderate sedation credentials:

More information

Center for Medicaid and State Operations/Survey and Certification Group

Center for Medicaid and State Operations/Survey and Certification Group DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-12-25 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations/Survey

More information

Healthcare Inspection. Evaluation of Management of Moderate Sedation in Veterans Health Administration Facilities

Healthcare Inspection. Evaluation of Management of Moderate Sedation in Veterans Health Administration Facilities Department of Veterans Affairs Office of Inspector General Healthcare Inspection Evaluation of Management of Moderate Sedation in Veterans Health Administration Facilities Report No. 04-00330-15 November

More information

1.4.4 Oxyhemoglobin desaturation

1.4.4 Oxyhemoglobin desaturation Critical Care Therapy and Respiratory Care Section Category: Clinical Section: Clinical Monitoring Title: Monitoring of Patients Undergoing Conscious Sedation Policy #: 09 Revised: 05/00 1.0 DESCRIPTION

More information

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia

More information

Minimal and Moderate Sedation Services in Dentistry

Minimal and Moderate Sedation Services in Dentistry STANDARDS & GUIDELINES Minimal and Moderate Sedation Services in Dentistry (Non-Hospital Facilities) TABLE OF CONTENTS Standards and guidelines inform practitioners and the public of CDSBC s expectations

More information

CHAPTER 8 MODERATE SEDATION/ANALGESIA

CHAPTER 8 MODERATE SEDATION/ANALGESIA MODERATE SEDATION/ANALGESIA Linda Wilson, PhD, RN, CPAN, CAPA, BC, CNE Christine Price, MSN, RN, CPAN, CAPA H. Lynn Kane, MSN, MBA, RN, CCRN Linda J. Webb, MSN, RN, CPAN OVERVIEW Purpose: The orientee

More information

COMPLIANCE WITH THIS PUBLICATION IS MANDATORY

COMPLIANCE WITH THIS PUBLICATION IS MANDATORY BY ORDER OF THE COMMANDER 59TH MEDICAL WING 59TH MEDICAL WING INSTRUCTION 44-137 20 DECEMBER 2013 Certified Current 04 May 2016 Medical POLICY AND PROCEDURE FOR MODERATE SEDATION COMPLIANCE WITH THIS PUBLICATION

More information

SUBJECT: Moderate Sedation POLICY NUMBER: PAMC/MS 951.140 Policy Type: Patient Care New Revised Reviewed EXECUTIVE Approval: Date Signed: 10.29.

SUBJECT: Moderate Sedation POLICY NUMBER: PAMC/MS 951.140 Policy Type: Patient Care New Revised Reviewed EXECUTIVE Approval: Date Signed: 10.29. SUBJECT: Moderate Sedation POLICY NUMBER: PAMC/MS 951.140 Policy Type: Patient Care New Revised Reviewed EXECUTIVE Approval: Date Signed: 10.29.2014 /s/ Richard D. Mandsager, MD, Chief Executive Providence

More information

Pain Control and Sedation Techniques For Dentists

Pain Control and Sedation Techniques For Dentists Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students I. Introduction The administration of local anesthesia, sedation and general anesthesia is an integral part of the practice

More information

G U I D E L I N E S for Teaching Pain Control and Sedation to Dentists and Dental Students. As adopted by the October 2007 ADA House of Delegates

G U I D E L I N E S for Teaching Pain Control and Sedation to Dentists and Dental Students. As adopted by the October 2007 ADA House of Delegates for Teaching Pain Control and Sedation to Dentists and Dental Students As adopted by the October ADA House of Delegates I. INTRODUCTION The administration of local anesthesia, sedation and general anesthesia

More information

Moderate Sedation Core Competency Course 2012

Moderate Sedation Core Competency Course 2012 Moderate Sedation Core Competency Course 2012 University of California San Diego Medical Center Revised September 2011 Objectives State competency requirements for RNs & MDs assisting with Moderate Sedation

More information

ANESTHESIA - Medicare

ANESTHESIA - Medicare ANESTHESIA - Medicare Policy Number: UM14P0008A2 Effective Date: August 19, 2014 Last Reviewed: January 1, 2016 PAYMENT POLICY HISTORY Version DATE ACTION / DESCRIPTION Version 2 January 1, 2016 Under

More information

Moderate Sedation. A Self-Learning Module

Moderate Sedation. A Self-Learning Module Moderate Sedation A Self-Learning Module Moderate Sedation This self-learning module is required for health care professionals monitoring patients receiving or recovering from sedation. IV moderate sedation

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Sedation for diagnostic and therapeutic procedures in children and young people 1.1 Short title Sedation in children and young

More information

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION Hospital Policy Manual Purpose: To define the components of the paper and electronic medical record

More information

SUBJECT: PROCEDURAL SEDATION

SUBJECT: PROCEDURAL SEDATION This policy applies to the following entity(s): Children s Hospital and Health System, Inc. Patient Care Policy and Procedure Children s Hospital of Wisconsin Children s Hospital of WI-Kenosha Children

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines MOH CLINICL PRCTICE GUIELINES 2/2008 Prescribing of Benzodiazepines College of Family Physicians, Singapore cademy of Medicine, Singapore Executive summary of recommendations etails of recommendations

More information

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley

More information

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No.

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No. M07 Medications 2015-07-15 All ages EMS Branch / Office of the Medical Director Benzodiazepines Primary Intermediate Advanced Critical INDICATIONS Diazepam (c) Lorazepam (c) Midazolam (c) Intranasal Midazolam

More information

INOVA FAIRFAX HOSPITAL REQUEST FOR PRIVELAGES TO ADMINISTER MODERATE SEDATION

INOVA FAIRFAX HOSPITAL REQUEST FOR PRIVELAGES TO ADMINISTER MODERATE SEDATION INOVA FAIRFAX HOSPITAL REQUEST FOR PRIVELAGES TO ADMINISTER MODERATE SEDATION Name: Department: I hereby request privileges to adister Moderate Sedation in accordance with the INOVA Health System. INOVA

More information

Title/Description: Admission Criteria, Discharge Criteria, and Standards of Operation of the Pediatric Intensive Care Unit.

Title/Description: Admission Criteria, Discharge Criteria, and Standards of Operation of the Pediatric Intensive Care Unit. University of Kentucky / UK HealthCare Policy and Procedure Policy # CH02-02 Title/Description: Admission Criteria, Discharge Criteria, and Standards of Operation of the Pediatric Intensive Care Unit.

More information

Medical Malpractice - Preventing Sedation

Medical Malpractice - Preventing Sedation MODERATE/DEEP SEDATION PROVIDER COURSE A SELF-DIRECTED LEARNING MODULE 1. Moderate Sedation Learning Module.doc INTRODUCTION: This learning material is prepared to assist in educating and evaluating nonanesthesiology

More information

Fairfield Medical Center Attn: Medical Staff Services 401 N. Ewing Street Lancaster, Ohio 43130 Fax~ 740-687-8143

Fairfield Medical Center Attn: Medical Staff Services 401 N. Ewing Street Lancaster, Ohio 43130 Fax~ 740-687-8143 SUBJECT: Conscious Sedation Module* Please find enclosed the required Conscious Sedation Module from Fairfield Medical Center. Please be sure to fill out the answer sheet completely. The Post-Assessment

More information

Non-anesthesia Provider Procedural Sedation and Analgesia Considerations for Policy Development

Non-anesthesia Provider Procedural Sedation and Analgesia Considerations for Policy Development American Association of Nurse Anesthetists 222 South Prospect Avenue Park Ridge, IL 60068 www.aana.com Non-anesthesia Provider Procedural Sedation and Analgesia Considerations for Policy Development Purpose

More information

ANESTHESIA SERVICES (AS)

ANESTHESIA SERVICES (AS) ANESTHESIA SERVICES (AS) AS.1 ORGANIZATION SR.1 Anesthesia services shall be provided in an organized manner, and function under the direction of a qualified doctor of medicine or osteopathy (or other

More information

Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies.

Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies. Overview Estimated scenario time: 10 15 minutes Estimated debriefing time: 10 minutes Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies.

More information

X-Plain Preparing For Surgery Reference Summary

X-Plain Preparing For Surgery Reference Summary X-Plain Preparing For Surgery Reference Summary Introduction More than 25 million surgical procedures are performed each year in the US. This reference summary will help you prepare for surgery. By understanding

More information

Community Ambulance Service of Minot ALS Standing Orders Legend

Community Ambulance Service of Minot ALS Standing Orders Legend Legend Indicates General Information and Guidelines Indicates Procedures Indicates Medication Administration Indicates Referral to Other Protocol Indicates Referral to Online Medical Direction Pediatric

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: CSD - Suboxone Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Analgesics and Antipyretics (Opiate Partial Agonists) Client: County of San

More information

TRANSPORT OF CRITICALLY ILL PATIENTS

TRANSPORT OF CRITICALLY ILL PATIENTS TRANSPORT OF CRITICALLY ILL PATIENTS Introduction Inter-hospital and intra-hospital transport of critically ill patients places the patient at risk of adverse events and increased morbidity and mortality.

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

9/16/2010. Contact Information. Objectives. Analgesic Ketamine (Ketalar )

9/16/2010. Contact Information. Objectives. Analgesic Ketamine (Ketalar ) Analgesic Ketamine (Ketalar )..the long and winding road to clinical practice Contact Information Lois Pizzi BSN, RN-BC Inpatient Pain Management Clinician UPMC Presbyterian Shadyside pizzilj@upmc.edu

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY

CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY ANESTHESIA BILLING: MUST BE DOCUMENTED AS: Personally performed: you perform the case without a resident or a CRNA

More information

Drug Shortage Alert 8/1/2014

Drug Shortage Alert 8/1/2014 Headquarters 500 Midway Drive Mount Prospect, Illinois 60056-5811 USA Main Telephone +1 847 827-6869 Customer Service +1 847 827-6888 Facsimile +1 847 827-6886 Email info@sccm.org www.sccm.org Drug Shortage

More information

ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC. BLS Changes

ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC. BLS Changes ACLS Provider Manual Comparison Sheet Based on 2010 AHA Guidelines for CPR and ECC CPR Chest compressions, Airway, Breathing (C-A-B) BLS Changes New Old Rationale New science indicates the following order:

More information

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the

More information

RECOMMENDATIONS FOR SEDATION AND ANALGESIA BY NON-ANAESTHESIOLOGISTS

RECOMMENDATIONS FOR SEDATION AND ANALGESIA BY NON-ANAESTHESIOLOGISTS RECOMMENDATIONS FOR SEDATION AND ANALGESIA BY NON-ANAESTHESIOLOGISTS TERUS MAJU College of Anaesthesiologists Academy of Medicine of Malaysia Academy of Medicine of Malaysia December 2012 With the participation

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE

DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE REFERENCES: The Joint Commission Accreditation Manual for Hospitals American Society of Post Anesthesia Nurses: Standards of Post Anesthesia Nursing Practice (1991, 2002). RELATED DOCUMENTS: SHC Administrative

More information

Sedation-Analgesia Quality Improvement

Sedation-Analgesia Quality Improvement Sedation Analgesia Credentialing For New Credentialing Completion of the Sedation Analgesia Course and satisfactory completion of the post-course test. ACLS or PALS certification For Renewal Performance

More information

75-09.1-08-02. Program criteria. A social detoxi cation program must provide:

75-09.1-08-02. Program criteria. A social detoxi cation program must provide: CHAPTER 75-09.1-08 SOCIAL DETOXIFICATION ASAM LEVEL III.2-D Section 75-09.1-08-01 De nitions 75-09.1-08-02 Program Criteria 75-09.1-08-03 Provider Criteria 75-09.1-08-04 Admission and Continued Stay Criteria

More information

The applicant may demonstrate current training/education or competency by any one of the following:

The applicant may demonstrate current training/education or competency by any one of the following: Board of Dentistry 1500 SW 1st Avenue Suite 770 Portland, OR 97201-5828 (971) 673-3200 Fax: (971) 673-3202 www.oregon.gov/dentistry EDUCATIONAL REQUIREMENTS FOR NITROUS OXIDE, MINIMAL SEDATION, MODERATE

More information

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008

Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble In contrast to cardiac arrest in adults, cardiopulmonary arrest in pediatric

More information

NURSING SERVICES DEPARTMENT

NURSING SERVICES DEPARTMENT NURSING SERVICES DEPARTMENT TITLE: Mechanical Ventilation PATIENT CARE PLAN DIAGNOSIS: DISCHARGE CRITERIA: 1 The patient will: Maintain adequate mechanics of PERTINENT INFORMATION:. ventilation as demonstrated

More information

Where it all began 9/28/2013 THE ADA ANESTHESIA GUIDELINES AND POLICY STATEMENT

Where it all began 9/28/2013 THE ADA ANESTHESIA GUIDELINES AND POLICY STATEMENT THE ADA ANESTHESIA GUIDELINES AND POLICY STATEMENT ROBERT M. PESKIN, D.D.S. American Academy of Periodontology 99 th Annual Meeting Philadelphia, PA September 27 30, 2013 Where it all began "...only 17

More information

R156. Commerce, Occupational and Professional Licensing. R156-69. Dentist and Dental Hygienist Practice Act Rule. R156-69-101. Title.

R156. Commerce, Occupational and Professional Licensing. R156-69. Dentist and Dental Hygienist Practice Act Rule. R156-69-101. Title. R156. Commerce, Occupational and Professional Licensing. R156-69. Dentist and Dental Hygienist Practice Act Rule. R156-69-101. Title. This rule is known as the "Dentist and Dental Hygienist Practice Act

More information

Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes

Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes Nursing home patients with diabetes treated with insulin and certain oral diabetes medications (i.e. sulfonylureas and glitinides) are

More information

PARAMEDIC TRAINING CLINICAL OBJECTIVES

PARAMEDIC TRAINING CLINICAL OBJECTIVES Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members

More information

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Isoproterenol Major Indications Status Asthmaticus As a last resort for

More information

VA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 118-28 SAN DIEGO, CA

VA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 118-28 SAN DIEGO, CA GUIDELINES FOR PATIENT-CONTROLLED ANALGESIA (PCA) AND PATIENT- CONTROLLED EPIDURAL ANALGESIA (PCEA) FOR ACUTE PAIN MANAGEMENT 1. PURPOSE: To assure the safe and effective use of patient controlled analgesia

More information

Multisociety sedation curriculum for gastrointestinal endoscopy

Multisociety sedation curriculum for gastrointestinal endoscopy SEDATION CURRICULUM Multisociety sedation curriculum for gastrointestinal endoscopy TABLE OF CONTENTS Introduction Vargo Sedation Pharmacology DeLegge Informed Consent for Endoscopic Sedation Feld Periprocedure

More information

Critical Care Therapy and Respiratory Care Section

Critical Care Therapy and Respiratory Care Section Critical Care Therapy and Respiratory Care Section Category: Clinical Section: Special Procedures Title: Transport of Critically Ill Patients Policy #: 05 Revised: 04/00 1.0 DESCRIPTION 1.1 Definition:

More information

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool The Pharmacological Management of Cancer Pain in Adults Clinical Audit Tool 2015 This clinical audit tool accompanies the Pharmacological Management of Cancer Pain in Adults NCEC National Clinical Guideline

More information

October 2010. Moderate Sedation Review

October 2010. Moderate Sedation Review Little Booklet October 2010 Moderate Sedation Review All non-physician ACLS professional staff that induces moderate sedation must review and complete this Booklet & quiz. Please return your completed

More information

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC Acute Pain Management in the Opioid Dependent Patient Maripat Welz-Bosna MSN, CRNP-BC Relieving Pain in America (IOM) More then 116 Million Americans have pain the persists for weeks to years $560-635

More information

r JOHNS HOPKINS HEALTHCARE Physician Guidelines Subject: Anesthesia Processing Guidelines Lines of Business: EHP, USFHP, Priority Partners

r JOHNS HOPKINS HEALTHCARE Physician Guidelines Subject: Anesthesia Processing Guidelines Lines of Business: EHP, USFHP, Priority Partners Revision Date: 11/14/14 Last Reviewed Date: 11/14/14 Page 1 of 7 ACTION New Procedure Amending Procedure Number: Superseding Procedure Number: Repealing Procedure Number: REFERENCES: AMPT Committee ASA

More information

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses

More information

Scope and Standards for Nurse Anesthesia Practice

Scope and Standards for Nurse Anesthesia Practice Scope and Standards for Nurse Anesthesia Practice Copyright 2013 222 South Prospect Ave. Park Ridge, IL 60068 www.aana.com Scope and Standards for Nurse Anesthesia Practice The AANA Scope and Standards

More information

519.2 ANESTHESIA SERVICES. Background... 2. Policy... 2. 519.2.1 Covered Services... 2. 519.2.1.1 Anesthesiologist Directed Services...

519.2 ANESTHESIA SERVICES. Background... 2. Policy... 2. 519.2.1 Covered Services... 2. 519.2.1.1 Anesthesiologist Directed Services... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 519.2.1 Covered Services... 2 519.2.1.1 Anesthesiologist Directed Services... 3 519.2.1.2 Emergency Anesthesia... 4 519.2.1.3 Monitored

More information

Texas Board of Nursing 333 Guadalupe, Suite 3-460 Austin, TX 78701

Texas Board of Nursing 333 Guadalupe, Suite 3-460 Austin, TX 78701 Texas Board of Nursing 333 Guadalupe, Suite 3-460 Austin, TX 78701 FROM: APN Office, Phone: (512) 305-6843; Fax: (512) 305-7401 ******************************************************************************************

More information

ANESTHESIA. Anesthesia for Ambulatory Surgery

ANESTHESIA. Anesthesia for Ambulatory Surgery ANESTHESIA & YOU Anesthesia for Ambulatory Surgery T oday the majority of patients who undergo surgery or diagnostic tests do not need to stay overnight in the hospital. In most cases, you will be well

More information

Purpose: To outline training and competency standards for non-physician staff who supervise cardiac stress tests at UK HealthCare.

Purpose: To outline training and competency standards for non-physician staff who supervise cardiac stress tests at UK HealthCare. University of Kentucky / UK HealthCare Policy and Procedure Policy # A09-140 Title/Description: Cardiac Stress Test Supervision by Non-Physician Staff Purpose: To outline training and competency standards

More information

ACR SIR PRACTICE PARAMETER FOR SEDATION/ANALGESIA

ACR SIR PRACTICE PARAMETER FOR SEDATION/ANALGESIA The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College

More information

University of Michigan Alcohol Withdrawal Guidelines Overview

University of Michigan Alcohol Withdrawal Guidelines Overview University of Michigan Alcohol Withdrawal Guidelines Overview The following document contains the University of Michigan Alcohol Withdrawal Guidelines. These guidelines were developed through an intensive

More information

Targeting patients for use of dexmedetomidine

Targeting patients for use of dexmedetomidine Targeting patients for use of dexmedetomidine H a n n a h W u n s c h, M D M S c H e r b e r t I r v i n g A s s i s t a n t P r o f e s s o r o f A n e s t h e s i o l o g y & E p i d e m i o l o g y

More information

Common Surgical Procedures in the Elderly

Common Surgical Procedures in the Elderly Common Surgical Procedures in the Elderly From hip and knee replacements to cataract and heart surgery, America s elderly undergo 20% of all surgical procedures. For a group that comprises only 13% of

More information

General PROVIDER INITIALS: PHYSICIAN ORDERS

General PROVIDER INITIALS: PHYSICIAN ORDERS Height Weight Allergies If appropriate for patient condition, please consider the following order sets: Initiate Electrolyte Replcement: Med/Surg, Med/Surg Tele Physician Order #842 General Vital Signs

More information

WITHDRAWAL OF ANALGESIA AND SEDATION

WITHDRAWAL OF ANALGESIA AND SEDATION WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening drug doses

More information