BACKGROUND: In 1995 The Johns Hopkins Hospital in Baltimore convened an interdisciplinary task force to evaluate sedation practices, create a comprehensive set of sedation guidelines, and evaluate patient safety outcomes following guideline implementation. METHODOLOGY: Baseline data were collected on all procedures in which sedation was administered by a nonanesthesiologist for a 6-month period, using scanning technology to automate data entry. Sedation practices were reviewed, and four critical events were examined: unresponsiveness, obstructed airway, airway placement, and cardiopulmonary resuscitation (CPR). In 1998 data collection procedures were repeated to evaluate the impact of the guidelines on sedation practices and patient safety outcomes. RESULTS: In 1995 sedation practices varied, and one or more critical events occurred in 45 (1.4%) of 3,255 procedures. Steps taken included development and dissemination of a clinical sedation guideline, including monitoring criteria to guide nonanesthesiologists, and evaluation planning. In 1998 sedation practices were more consistent. One or more critical events occurred in 50 (1.6%) of 3,134 procedures, representing a small increase in critical events from 1995. More events of unresponsiveness were identified, and no event required CPR. Although not statistically significant, this trend suggests that critical events were being identified earlier, preventing patients from progressing to a more serious event requiring CPR. Steps taken included further refinement of clinical practice guidelines and establishment of ongoing monitoring. CONCLUSIONS: Standardization of sedation practices is a complex and resource-intensive activity, requiring ongoing oversight and monitoring. Commitment from medical staff, nursing staff, and administration is essential to successful implementation of sedation guidelines.
BACKGROUND: In 1995 The Johns Hopkins Hospital in Baltimore convened an interdisciplinary task force to evaluate sedation practices, create a comprehensive set of sedation guidelines, and evaluate patient safety outcomes following guideline implementation. METHODOLOGY: Baseline data were collected on all procedures in which sedation was administered by a nonanesthesiologist for a 6-month period, using scanning technology to automate data entry. Sedation practices were reviewed, and four critical events were examined: unresponsiveness, obstructed airway, airway placement, and cardiopulmonary resuscitation (CPR). In 1998 data collection procedures were repeated to evaluate the impact of the guidelines on sedation practices and patient safety outcomes. RESULTS: In 1995 sedation practices varied, and one or more critical events occurred in 45 (1.4%) of 3,255 procedures. Steps taken included development and dissemination of a clinical sedation guideline, including monitoring criteria to guide nonanesthesiologists, and evaluation planning. In 1998 sedation practices were more consistent. One or more critical events occurred in 50 (1.6%) of 3,134 procedures, representing a small increase in critical events from 1995. More events of unresponsiveness were identified, and no event required CPR. Although not statistically significant, this trend suggests that critical events were being identified earlier, preventing patients from progressing to a more serious event requiring CPR. Steps taken included further refinement of clinical practice guidelines and establishment of ongoing monitoring. CONCLUSIONS: Standardization of sedation practices is a complex and resource-intensive activity, requiring ongoing oversight and monitoring. Commitment from medical staff, nursing staff, and administration is essential to successful implementation of sedation guidelines.
Authors: Rina Mina; Emily von Scheven; Stacy P Ardoin; B Anne Eberhard; Marilynn Punaro; Norman Ilowite; Joyce Hsu; Marisa Klein-Gitelman; L Nandini Moorthy; Eyal Muscal; Suhas M Radhakrishna; Linda Wagner-Weiner; Matthew Adams; Peter Blier; Lenore Buckley; Elizabeth Chalom; Gaëlle Chédeville; Andrew Eichenfield; Natalya Fish; Michael Henrickson; Aimee O Hersh; Roger Hollister; Olcay Jones; Lawrence Jung; Deborah Levy; Jorge Lopez-Benitez; Deborah McCurdy; Paivi M Miettunen; Ana I Quintero-del Rio; Deborah Rothman; Ornella Rullo; Natasha Ruth; Laura E Schanberg; Earl Silverman; Nora G Singer; Jennifer Soep; Reema Syed; Larry B Vogler; Ali Yalcindag; Cagri Yildirim-Toruner; Carol A Wallace; Hermine I Brunner Journal: Arthritis Care Res (Hoboken) Date: 2012-03 Impact factor: 4.794