Keeping conscious sedation safe

Nursing, Jun 1998

TH EHT RECOMMENDED PRACTICES WERE DEVELOPED BY THE ASSOCIATION OF OPERATING ROOM NURSES TO ENSURE APPROPRIATE NURSING CARE.

TAKING PRECAUTIONS

Make sure the following equipment is present and ready to use in case your patient experiences complications:

oxygen and oxygen delivery device

suction apparatus

noninvasive blood pressure device

ECG

pulse oximeter

emergency cart with resuscitative medications.

Keep an eye out for the patient's respiratory rate, oxygen saturation level, blood pressure, cardiac rate and rhythm, level of consciousness, and skin condition. Report any undesirable changes immediately to the physician.

1 You should understand the goals and objectives of conscious sedation.

Conscious sedation allows a patient to tolerate unpleasant procedures. It reduces his anxiety and discomfort and facilitates cooperation between him and his caregivers. During conscious sedation, he should maintain the ability to respond independently to verbal commands or physical stimulation.

2 You should have no other responsibilities that would require you to leave the patient unattended or compromise continued monitoring during the procedure.

It's unrealistic to assume that one nurse can perform circulating duties while providing continuous monitoring, physical care, and emotional support to the patient receiving conscious sedation. You must be able to immediately recognize and respond to adverse physiologic and psychological changes during the procedure.

3 You should be clinically competent in the function and use of resuscitation medications and monitoring equipment and be able to interpret patient data.

You should demonstrate knowledge of anatomy and physiology, pharmacology of medications used for conscious sedation, cardiac arrhythmia interpretation, possible complications related to conscious sedation, and respiratory functions, including oxygen delivery, transport, uptake, and airway management. (Your institution's policies and procedures will determine what your skill level should be regarding these subjects.)

4 Each patient receiving conscious sedation should be assessed physiologically and psychologically before the procedure.

Note physical examination findings; current medications; drug allergies/sensitivities; current medical problems; tobacco smoking and substance abuse history; chief complaint; baseline vital signs, including height, weight, and age; level of consciousness; emotional state; communication ability; and perceptions regarding the procedure and conscious sedation.

5 You should monitor for adverse reactions to medications and for physiologic and psychological changes.

You should understand the medications' indications and dosages, contraindications, adverse effects and emergency management techniques, interactions with other medications, and the onset and duration of action. Watch for such complications as aspiration, severely slurred speech, unarousable sleep, hypotension, agitation, combativeness, hypoventilation, respiratory depression, airway obstruction, and apnea. (See Taking Precautions.) Also, be on the lookout for general physiologic and psychological changes.

6 Your conscious sedation documentation should be consistent with any documentation you do for preoperative care.

Keep a record of the preprocedure assessment; the dosage, route, time, and effects of all medications and fluids used; the type and amount of fluids administered, including blood, blood products, monitoring devices, and equipment used; physiologic data from continuous monitoring at 5- to 15-minute intervals and significant events; level of consciousness; nursing interventions with patient's responses; and adverse patient reactions and resolutions.

7 Your patient should be monitored postprocedure, receive verbal and written discharge instructions, and meet specified criteria before discharge.

Inform family members that conscious sedation may cause significant patient amnesia. Before discharge, check that he shows signs of adequate respiratory function, stable vital signs, preprocedure level of consciousness, motor/sensory control, normal skin color and condition, and satisfactory surgical site and dressing condition. Your patient shouldn't feel significant pain or nausea. Also, make sure an adult is available to escort your patient home.

8 Your institution should have written policies and procedures for managing patients who receive conscious sedation.

These policies should be reviewed periodically and be readily available within the practice setting.

TAKING IT TO THE UNIT

Be sure to keep these recommendations in mind and refer to them frequently. By staying knowledgeable about conscious sedation, you can ensure a safe, smooth procedure.

From "Recommended Practices for Managing the Patient Receiving Conscious Sedation/Analgesia," in AORN Journal. tO January 1997 Association of Operating Room Nurses, Denver. Adapted with permission from the publisher.