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New outpatient sedation guidelines

Article-New outpatient sedation guidelines

Oak Brook, Ill. — Hospitals are adopting strict new policies for the safe administration of short-acting sedatives used in outpatient surgical procedures, including new training to help doctors and nurses better respond when things go wrong.

According to Oak Brook-based University HealthSystem Consortium (UHC), which includes 95 of the nation’s largest academic medical centers, recent data suggest that there may be nearly 1,700 incidents a year nationwide related to sedation, ranging from an overdose of drugs to procedures starting before a patient is adequately sedated. Due partly to recent advances in so-called conscious sedation, nearly 70 percent of surgical procedures are now performed in hospital outpatient departments, surgical centers and doctors’ offices. With the latest sedating drugs, including fentanyl and Versed (Hoffman-LaRoche), doctors can now perform operations ranging from tummy tucks to cardiac catheterizations without the need for general anesthesia or an overnight hospital stay.

The downside, say safety experts, is that sedatives are more often being administered by medical professionals who are not adequately trained in anesthesia and safety practices, increasing the risks of respiratory complications, cardiac arrest, brain damage and even death.

In an effort to minimize these risks, hospitals are adopting strict new credentialing programs for anyone who administers anesthesia, with re-certification every two years. UHC, which issued “best practice” recommendations for moderate sedation last year, is finalizing new recommendations for deep sedation, which will be issued later this year. Among its recommendations: that so-called rescue drugs to reverse the effects of sedatives be kept in the operating room, and that providers who administer deep sedation be trained in advanced life support, critical-care monitoring, and inserting breathing tubes.

In a survey of its members three years ago, the consortium found that 42 percent of hospitals do not require providers to have life-support training, even if a cardiac arrest team may not be available for more than five minutes. Only half of providers allowed to administer moderate sedation were trained in recognizing high-risk airways, or even basic airway management. For the past few years, the non-profit Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has required that hospitals have clear policies for administering moderate and deep sedation, and that staffers have appropriate credentials to manage whatever level of sedation occurs. Still, in a survey two years ago, JCHAO found that 18 percent of hospitals were not adhering to these standards.

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