Procedural Sedation Administered by Non-Anesthesiologist Providers

PATIENT CARE STANDARDTITLE:CLINICALLOCATIONS FORSEDATIONADMINISTRATION:REQUIREDEQUIPMENT ANDSUPPLIES:PROCEDURAL SEDATION ADMINISTERED BY NON-ANESTHESIOLOGISTPROVIDERS, MODERATE AND/OR DEEP SEDATIONProcedural sedation may be administered in areas where the patient can beadequately and safely monitored as outlined in this policy. See Appendix B.To ensure patient safety and the rapid ability to rescue patients, the followingequipment and supplies must be readily available:• Crash crash/defibrillator – age appropriate• Oxygen source and equipment/supplies for administering supplementaloxygen (cannula, mask) – age appropriate• Emergency advanced airway/intubation equipment – age appropriate• Bag-valve mask – age appropriate• Working suction source and equipment/supplies required for suctioning• Patient monitoring equipment: cardiac monitor, non-invasive bloodpressure monitor, pulse oximetry, and end-tidal CO2 monitor• Sedation medications and appropriate antagonists/reversal agents.SMCS: Procedure FlowsheetREQUIREMENTS/RESPONSIBILITES:NON-ANESTHESIOLOGIST PHYSICIAN PROVIDER REQUIREMENTS:The physician ordering/overseeing/administering sedation must:• Hold current medical staff credentials for procedural sedation.• Hold a valid DEA license to prescribe the selected sedatives andanalgesics.RN COMPETENCY REQUIREMENTS:• For adult patients: Completion of hospital sponsored Sedation Trainingcourse.• For pediatric patients less than 14 years of age: Completion of hospitalsponsored Adult and Pediatric Sedation Training.• Current certification in an age appropriate advanced cardiac life supportcourse, such as ACLS, PALS, NRP. NICU: RN must also have ALSdesignation.REQUIRED PERSONNEL REQUIRED FOR PROCEDURAL SEDATION:In addition to the practitioner performing the procedure, sufficient numbers ofqualified personnel must be present for all procedures requiring moderate ordeep sedation.• One health care provider (an RN or physician who is competent insedation management and is not the physician performing theprocedure) must have the primary responsibility of monitoring thepatient, including vital signs and level of consciousness. This personcannot leave the room/suite during the procedure.• For the adult patient, a second health care provider may be required toassist as directed with sedation monitoring. This person must be BLScertified.I:ProceduralSedationNonAnesthProviders.doc (April 2012) Page 4 of 9