PRE-SEDATION EVALUATION FORM (DRAFT) - Mission Health

Policy #300.005 – Sedation Page 7 of 7POST PROCEDURE MANAGEMENT FOR MODERATE OR DEEP SEDATION:1. Patients who receive sedation will be monitored post procedure. They will be consideredrecovered when monitoring shows a return to safe physiological and psychological levels. Anequivalent to the Aldrete Scoring System will be used.Deleted: This flow sheet will be deletedLou2. Any person receiving a reversal agent must be observed for one hour after the last dose ofreversal agent.3. Inpatient monitoring and documentation:A. Blood pressure, pulse, respirations, oxygen saturation, and level of consciousness at leastevery fifteen minutes.B. Observation of any post procedure complications, management of those events, andpatient response.C. Name, dose, time, route and response of any medications given in the post procedureperiod.D. Discharge summary and verbal report to nurse caring for patient on patient care unit.Include pre-procedure vital signs and level of consciousness, any problems encounteredduring or post procedure, total medications given, IV fluid total, and status of IV.4. Outpatient monitoring and documentation:A. Blood pressure, pulse, respiration, oxygen saturation, and level of consciousness at leastevery fifteen minutes.B. Observation of any post procedure complications, management of those events andpatient response.C. Name, dose, time, route and response of any medications given in the post procedureperiod.D. Verbal and written discharge instructions to patient and responsible adult accompanyingpatient and driving them home to include restrictions following sedation.PERFORMANCE IMPROVEMENT:The Chairperson or designee of the Anesthesiology Clinical Service is responsible to oversee themonitoring and evaluation of sedation use. The following data is gathered for review following theadministration of sedation:> Unplanned intubation> Unplanned admission or transfer to higher level of care> Administration of reversal agent> Drop in oxygen saturation to less than 92% not responsive rapidly to oxygen therapy> Nausea and vomiting> Unable to complete procedure> Achieved sedation level deeper than intent> Failure to comply with documentation requirementsCMS: WHAT CONSTITUTES ... [1]