Sedation

1. Sedation

2. 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

3. 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

4. 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.

5. 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.

6. Equipment Requirements • Crash cart (or appropriate components) with defibrillator • Reversal medications • Oxygen and Suction • Pulse oximeter and automated B/P monitor

7. 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

8. 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

9. 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

10. 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)

12. 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