This document discusses sedation and guidelines for qualified sedation providers. It defines levels of sedation from minimal to general anesthesia. Certified registered nurse anesthetists, anesthesiologists, and specifically trained physicians, dentists, oral surgeons, and registered nurses can provide conscious sedation. The American Society of Anesthesiologists' practice guidelines for non-anesthesiologist sedation were developed through an extensive review process. The guidelines also address training requirements for sedation personnel. Kaiser Moanalua's registered nurse training involves an online test and hands-on training in an operating room. A sedation simulation aims to supplement online training through realistic scenarios that simulate dynamic decision making. Evaluation of the simulation involves surveys of

1. Stephanie Ricketts
NURS 693
Spring 2015

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

8. Sedation Simulation
Objectives
1. Supplement online competency
2. Realistic & consistent training
3. Simulate dynamic decision making process
used in 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
✔
✔

10. Evaluation
1. Trial simulation posttest & survey
2. Nurse & Patient satisfaction surveys

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.