Procedural Sedation Administered by Non-Anesthesiologist Providers

PATIENT CARE STANDARDTITLE:REQUIREMENTS/RESPONSIBILITESCONTINUED:PROCEDURAL SEDATION ADMINISTERED BY NON-ANESTHESIOLOGISTPROVIDERS, MODERATE AND/OR DEEP SEDATIONdocumented:a. Blood pressure, pulse oximetry, end tidal CO2 or TCM, respiratoryrate, heart rate and level of sedation.4. If assessing level of sedation compromises and/or disrupts theprocedure, the reason must be documented.5. It is the responsibility of the RN to keep the physician informed ofpatient status throughout the duration of the sedation. This includes:a. Patient assessment information.b. Loss of protective reflexes.c. Inability to maintain a patent airway.d. Variations in vital signs indicating potential change in patientstatus.e. Amount of medication given per physician order.6. The RN is to notify the physician immediately if the patient experiences:a. Baseline oxygen saturation of less than 93%, a decrease in oxygensaturation from a low saturation baseline, or a fall in oxygensaturation of 5% or greater.b. Inadequate ventilation and/or inability to maintain a patent airway.c. Inability to respond appropriately to physical stimulation/verbalcommands.d. Hemodynamic instability, as evidenced by hypotension, arrhythmia,chest pain, shortness of breath.e. Other adverse reactions to drugs administered.7. Should any of the above changes occur, implement the followingmeasures:a. Give supplemental oxygen as ordered by the physician.8. If saturation does not improve:a. Stimulate the patient.b. Halt procedure.c. Attempt to improve the airway with jaw thrust and/ororal/nasopharyngeal airway.d. Initiate or assist ventilation with bag/valve/mask and oxygen.e. Administer reversal agents as ordered.f. Initiate cardiopulmonary resuscitation procedures as needed.1) If endotracheal intubation is employed, determine correct tubeplacement by carbon dioxide detection, presence of equalbreath sounds and presence of chest rise. When appropriate,tube position should be verified by x-ray.PHYSICIAN REQUIREMENTS FOLLOWING PROCEDURAL SEDATIONI:ProceduralSedationNonAnesthProviders.doc (April 2012) Page 7 of 9