2. OBJECTIVES
Define sedations &
qualified providers
Discuss practice guidelines
Describe training at Kaiser
Examine CNS
competencies utilized
3. DEFINTION
Conscious sedation induces an altered state of
consciousness that minimizes pain and discomfort
through the use of pain relievers and sedatives.
Patients who receive conscious sedation usually are able
to speak and respond to verbal cues throughout the
procedure to communicate any discomfort.
Minimal
Sedation
Moderate
Sedation
Deep
Sedation
General
Anesthesia
4. Qualified Providers
Certified Registered Nurse Anesthetists (CRNAs)
Anesthesiologists
Physicians, dentists and oral surgeons
Specifically trained registered nurses may assist in
the administration of conscious sedation
5. Practice Guidelines for Sedation
and Analgesia by Non-
Anesthesiologists
Approved by American Society of
Anesthesiologists
51 consultants from 17 specialties
surveyed
1876 articles reviewed over
44 year period
Adopted by JCAHO
6. Practice Guidelines:
Training of Personnel
“The healthcare facility shall have in place an
educational/credentialing mechanism which includes a
process for evaluating and documenting the individual’s
competency relating to the management of patients
receiving sedation and analgesia.” -AANA
“Each organization
is free to define how
it will determine that
the individuals are
able to perform the
rescue”
-JCAHO 2009
7. RN Procedural Training at
Kaiser Moanalua
Part 1: Online competency test
Part 2: “Hands on” training in OR
UNREALISTIC
General
Anesthesia NOT
procedural
sedation
9. Progress thus far
Literature Review & data collection
Create/edit curriculum
Pilot Simulation
Evaluation
Simulation
Scenarios
• Routine Patient
• Allergic Reaction
• Hypoventilation
• Abnormal Cardiac
function
• Deterioration of
Mental Status
✔
✔
11. CNS Competencies
Utilized
Competency Sphere of Influence Nurse Characteristics Detailed Actions
performed
Consultation Nurse & System Facilitation of Learning,
collaboration & clinical
judgment
Initiated consultation
with CRNAs & clinical
educators while
collecting resources
Systems Leadership Nurse & System Collaboration &
systems thinking
Determined nursing
practice & system
interventions to promote
safety
Collaboration Nurse & System Clinical Inquiry &
Collaboration
Collaborated with
CRNAs, physicians &
RNs to ensure all needs
are addressed in
training.
Coaching Nurse Facilitator of learning &
clinical inquiry
Promoted professional
development through
presentation &
application of EB care
Research Nurse & System Clinical Inquiry,
systems thinking
Analyzed research
findings & other
clinical facts for
potential integration
to SIM
12. References
American Association of Nurse Anesthetists. Qualified Providers of Conscious Sedation Position
Statement 2.2. Park Ridge, IL: American Association of Nurse Anesthetists; 1996.
American Association of Nurse Anesthetists. Qualified Providers of Conscious Sedation Position
Statement 2.2. Park Ridge, IL: American Association of Nurse Anesthetists; 1996.
Caperelli-White, L., & Urman, R. D. (2014). Developing a Moderate Sedation Policy: Essential Elements and Evidence-Based Considerations. AORN
Journal, 99(3), 416-430. doi:10.1016/j.aorn.2013.09.015
Conway, A., Rolley, J., Page, K., & Fulbrook, P. (2014). Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac
catheterization laboratory: a modified Delphi study. Journal Of Advanced Nursing, 70(5), 1040-1053. doi:10.1111/jan.12337
Conway, A., Rolley, J., Page, K., & Fulbrook, P. (2014). Issues and challenges associated with nurse-administered procedural sedation and analgesia in the
cardiac catheterisation laboratory: a qualitative study. Journal Of Clinical Nursing, 23(3/4), 374-384. doi:10.1111/jocn.12147
Ketcham, E., Ketcham, C., & Bushnell, F. L. (2013). Patient safety and nurses' role in procedural sedation. Emergency Nurse,21(6), 20-24.
doi:10.7748/en2013.10.21.6.20.e1218
Murphy, J. M. (2013). Credentialing Process for Nurse Providers of Moderate Sedation. Journal Of Radiology Nursing, 32(1), 10-18.
doi:10.1016/j.jradnu.2012.06.002
Ogg, M. (2008). Clinical issues. Recommended practices for moderate sedation/analgesia. AORN Journal, 88(2), 275-277.
Registered Nurses Engaged in the Administration of Sedation and Analgesia. (2005, November 1). Retrieved May 7, 2015, from
http://www.aana.com/resources2/professionalpractice/Documents/PPM Consid 4.2 RNs Engaged in Sedation Analgesia.pdf
Spruce, L. (2015). Back to Basics: Procedural Sedation. AORN Journal, 101(3), 345-353. doi:10.1016/j.aorn.2014.09.011
Wunder L, Glymph D, Newman J, Gonzalez V, Gonzalez J, Groom J. Objective Structured Clinical Examination as an Educational Initiative for Summative
Simulation Competency Evaluation of First-Year Student Registered Nurse Anesthetists’ Clinical Skills. AANA Journal [serial online]. December
2014;82(6):419-425. Available from: CINAHL with Full Text, Ipswich, MA. Accessed April 5, 2015.
Editor's Notes
Discuss continuum of sedation.
Definition: Conscious, moderate or procedural I.V. sedation provides a minimally reduced level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.
Procedural sedation is extremely safe and effective when performed on well selected, adequately informed patients, by appropriately trained, credentialed and well supported providers.
But what qualifies a appropriately trained provider?
Identify the problem that the project addresses. Describe the significance and the rationale for the project in relation to the problem.
Explain why this is unrealistic and inadequate
Describe how the student modified or adapted the evidence to apply and/or use it to fit the particular patients and clinical context.
Describe objectives & proposed outcomes of project
DISCUSS FRAMEWORK
Describe the methods the student used or are using to evaluate the proposed benefits of “best practice.” A quality improvement framework or other evaluation methodology can be the basis of the evaluation. Please give consideration to including as benefits or outcomes not only patient health status, but also more consumer oriented ones such as satisfaction, as well as the impact of this practice on cost of care and staff outcomes.
Present findings of the evaluation to demonstrate the effects and benefits of best practice on the selected outcomes.
Discuss how I will evaluate
Describe what the student has learned from developing, implementing, and evaluating the use of a best practice to improve clinical.
Discuss the role of the CNS referencing the National Association of Clinical Nurse Specialists CNS Core Competencies (available on 693N site)
Discuss the role the student played in this project that reflects that of an advanced practice nurse. Summarize the most important lessons learned for CNS practice from the experience with this project.
Identify the most important implications for nursing practice that can be gained from this project