Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children. Achievement of discharge criteria reflects need for ongoing critical care nursing to monitor and intervene. <>stream Opening Document 100% Discharge Criteria for Phase I & II / 7 You are Here: Stanford Medicine School of Medicine Departments Anesthesia Ether Anesthesia Resources DASHBOARD Intranet Information Site Navigation: Nav 1 Nav 2 Nav 2_1 These guidelines do not address education, training, or certification requirements for practitioners who provide moderate procedural sedation. Although it is well accepted clinical practice to continue patient observation until discharge, the literature is insufficient to evaluate the impact of postprocedural observation and monitoring. They do not address mild or deep sedation and do not address the educational, training, or certification requirements for providers of moderate procedural sedation. Has 10 years experience. RL+tp l xnLnR%d`XpqMg]`M8+F*{M:\$?1. Cherry Hill, N.J.: American . A prospective study evaluating the usefulness of continuous supplemental oxygen in various endoscopic procedures. Phase 2 is only used for outpts. 3. Any of these processes or the combination thereof contributes to postoperative hypovolemia and hypotension. To assure that outpatients are discharged home safely and efficiently. The effect of supplemental oxygen on apnea and oxygen saturation during pediatric conscious sedation. Retrieved May 9, 2017, from http://www.asahq.org/quality-and-practice-management/standards-and-guidelines/search?q=basic anesthesia monitoring). Third, a panel of expert consultants was asked to (1) participate in opinion surveys on the effectiveness and safety of various methods and interventions that might be used during sedation/analgesia and (2) review and comment on a draft of the guidelines developed by the task force. c. Discharge score attained within acceptable range set by institutional policy. The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendation to assure that (1) pharmacologic antagonists for benzodiazepines and opioids are immediately available in the procedure suite or procedure room; (2) an individual is present in the room who understands the pharmacology of the sedative/analgesics administered and potential interactions with other medications and nutraceuticals the patient may be taking; (3) appropriately sized equipment for establishing a patent airway is available; (4) at least one individual capable of establishing a patent airway and providing positive pressure ventilation is present in the procedure room; (5) suction, advanced airway equipment, positive pressure ventilation, and supplemental oxygen are immediately available in the procedure room and in good working order; (6) a member of the procedural team is trained in the recognition and treatment of airway complications, opening the airway, suctioning secretions, and performing bag-valve-mask ventilation; (7) a member of the procedural team has the skills to establish intravascular access; (8) a member of the procedural team has the skills to provide chest compressions; (9) a functional defibrillator or automatic external defibrillator is immediately available in the procedure area; (10) an individual or service is immediately available with advanced life support skills; and (11) members of the procedural team are able to recognize the need for additional support and know how to access emergency services from the procedure room. Three-rater values were: (1) research design, = 0.70; (2) type of analysis, = 0.68; (3) linkage assignment, = 0.79; and (4) literature database inclusion, = 0.43. Describe commonly used post anesthesia care unit (PACU) discharge criteria. Pages 357-258, 1252-1253. PACU care is typically divided into two phases, Phase I as patients recover from anesthesia and Phase II as they prepare for discharge. Because it is not always possible to predict how a specific patient will respond to sedative and analgesic medications, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. %PDF-1.6 % To read this article in full you will need to make a payment, We use cookies to help provide and enhance our service and tailor content. Job in Plattsburgh - Clinton County - NY New York - USA , 12903. The Practice Guidelines for Postanesthetic Care are developed by the ASA Taskforce on Postanesthetic Care. There is a difference of opinion in our unit as to what ASPAN is stating in describing Phase I and Phase II level of care. After review, 1,140 were excluded, with 288 new studies meeting the above stated criteria. Phase II The phase of recovery needed to get the surgical patient to be discharged to the medical facilities. a. 5. 1. A. Nurse Practice Act: determining discharge readiness is a delegated act (refer to specific practice act of each state). Residential LED Lighting. : Midazolam/fentanyl, propofol/alfentanil, or alfentanil only for colonoscopy: A randomized trial. b. Apr 16, 2017. Preanesthesia Assessment and PACU Assessment and Discharge Criteria (PPDCW2342) 2.0 CH - Webcast - Thursday, February 9, 2023 . Patient Discharge Education in the Phase II Setting, 4. 10 0 obj <> endobj hb``e`` The presence of an individual in the procedure room with the knowledge and skills to recognize and treat airway complications. HeySis, BSN, RN. Then inpatients go to the floor and outpatients go to phase 2 to eat/drink, go to the bathroom and get up and ambulate before discharge to home. Patients receiving moderate procedural sedation may continue to be at risk for developing complications after their procedure is completed. A patient who receives anesthesia should receive appropriate postanesthesia care. Hypoxia and tachycardia during endoscopic retrograde cholangiopancreatography: Detection by pulse oximetry. Flumazenil in children after esophagogastroduodenoscopy. Anesthesiology 2018; 128:437479 doi: https://doi.org/10.1097/ALN.0000000000002043. A nonrandomized comparative study reported equivocal outcomes (e.g., emesis, apnea, oxygen levels) when preprocedure fasting (i.e., liquids or solids) is compared to no fasting (category B1-E evidence).27 Another nonrandomized comparison of fasting for less than 2h versus fasting for greater than 2h reported equivocal findings for emesis, oxygen saturation levels, and arrhythmia for infants (category B1-E evidence).28 Finally, a third nonrandomized comparison reported equivocal findings for gastric volume and pH when fasting of liquids for 0.5 to 3h is compared with fasting times of greater than 3h (category B1-E evidence).29. The consultants, ASA members, AAOMS members, and ASDA members agree with the recommendations to (1) periodically monitor a patients response to verbal commands during moderate sedation, except in patients who are unable to respond appropriately or during procedures where movement could detrimental clinically; and (2) during procedures where a verbal response is not possible, check the patients ability to give a thumbs up or other indication of consciousness in response to verbal or tactile (light tap) stimulation. 1. Midazolam-fentanyl intravenous sedation in children: Case report of respiratory arrest. Meta-analyses from other sources are reviewed but not included as evidence in this document. Opioids and hypnotics depress respiratory drive, airway reflexes, and airway patency. Level 2: The literature contains noncomparative observational studies with associative statistics (e.g., relative risk, correlation, sensitivity, and specificity). Implementing ASPAN Standards: Surgery Phase, PACU Phase I, Phase II and Extended Care Discharge criteria UNPLANNED PERIOPERATIVE HYPOTHERMIA Increased length of PACU, setting until discharge from all phases of postanesthesia care. Not surprisingly, respiratory incidents comprised the majority of the cases (49 of the 84), whereas cardiovascular incidents represented a minority (9 of 84). The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. %PDF-1.5 % In October 2014, the American Society of Anesthesiologists Committee on Standards and Practice Parameters recommended that new practice guidelines addressing moderate procedural sedation and analgesia be developed. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. They may vary depending upon whether the patient is discharged to a hospital room, to the Intensive Care Unit, to a short stay unit or home. UPON ARRIVAL IN THE PACU, THE PATIENT SHALL BE RE-EVALUATED AND A VERBAL REPORT PROVIDED TO THE RESPONSIBLE PACU NURSE BY THE MEMBER OF THE ANESTHESIA CARE TEAM WHO ACCOMPANIES THE PATIENT. The task force developed these guidelines by means of a seven-step process. 1. Create well-written care plans that meets your patient's health goals. Accueil Uncategorized aspan standards for phase 2 staffing. Therefore, ASPAN recommends that the ability to void be assessed . Finally, the consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendation to administer intravenous sedative/analgesic drugs in small, incremental doses, or by infusion, titrating to the desired endpoints. 7. Consultants were drawn from the following specialties where moderate procedural sedation/analgesia are commonly administered: anesthesiology, cardiology, dentistry, emergency medicine, gastroenterology, oral and maxillofacial surgery, pediatrics, radiology, and surgery. Diagnosis: analyze assessment data to determine nursing diagnosis 3. These guidelines focus specifically on the administration of moderate sedation and analgesia for adults and children. Sedation for colonoscopy using a single bolus is safe, effective, and efficient: A prospective, randomized, double-blind trial. Evidence was obtained from two principal sources: scientific evidence and opinion-based evidence. This practice is sometimes called fast-tracking. Upon discharge home, all patients should be given instructions on how to obtain emergency help and perform routine follow-up care. endstream endobj startxref continue the use of antiembolic stockings if ordered. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. ASPAN "retired" the position statement that said "It is, therefore, the position of ASPAN that two registered nurses, one competent in Phase I postanesthesia nursing, will be in the same unit where the patient is receiving Phase I level of care at all times . Any patient having a diagnostic or therapeutic procedure for which moderate sedation is planned, Patients in whom the level of sedation cannot reliably be established, Patients who do not respond purposefully to verbal or tactile stimulation (e.g., stroke victims, neonates), Patients in whom determining the level of sedation interferes with the procedure, Principal procedures (e.g., upper endoscopy, colonoscopy, radiology, ophthalmology, cardiology, dentistry, plastics, orthopedic, urology, podiatry), Diagnostic imaging (radiological scans, endoscopy), Minor surgical procedures in all care areas (e.g., cardioversion), Pediatric procedures (e.g., suture of laceration, setting of simple fracture, lumbar puncture, bone marrow with local, magnetic resonance imaging or computed tomography scan, routine dental procedures), Pediatric cardiac catheterization (e.g., cardiac biopsy after transplantation), Obstetric procedures (e.g., labor and delivery), Procedures using minimal sedation (e.g., anxiolysis for insertion of peripheral nerve blocks, local or topical anesthesia), Procedures where deep sedation is intended, Procedures where general anesthesia is intended, Procedures using major conduction anesthesia (i.e., neuraxial anesthesia), Procedures using sedatives in combination with regional anesthesia, Nondiagnostic or nontherapeutic procedures (e.g., postoperative analgesia, pain management/chronic pain, critical care, palliative care), Settings where procedural moderate sedation may be administered, Radiology suite (magnetic resonance imaging, computed tomography, invasive), All providers who deliver moderate procedural sedation in any practice setting, Physician anesthesiologists and anesthetists, Nursing personnel who perform monitoring tasks, Supervised physicians and dentists in training, Preprocedure patient evaluation and preparation, Medical records review (patient history/condition), Nonpharmaceutical (e.g., nutraceutical) use, Focused physical examination (e.g., heart, lungs, airway), Consultation with a medical specialist (e.g., physician anesthesiologist, cardiologist, endocrinologist, pulmonologist, nephrologist, obstetrician), Preparation of the patient (e.g., preprocedure instruction, medication usage, counseling, fasting), Level of consciousness (e.g., responsiveness), Observation (color when the procedure allows), Continual end tidal carbon dioxide monitoring (e.g., capnography, capnometry) versus observation or auscultation, Plethysmography versus observation or auscultation, Contemporaneous recording of monitored parameters, Presence of an individual dedicated to patient monitoring, Creation and implementation of quality improvement processes, Supplemental oxygen versus room air or no supplemental oxygen, Method of oxygen administration (e.g., nasal cannula, face masks, specialized devices (e.g., high-flow cannula), Presence of individual(s) capable of establishing a patent airway, positive pressure ventilation and resuscitation (i.e., advanced life-support skills), Presence of emergency and airway equipment, Types of airway devices (e.g., nasal cannula, face masks, specialized devices (e.g., high-flow cannula), Supraglottic airway (e.g., laryngeal mask airway), Presence of an individual to establish intravenous access, Intravenous access versus no intravenous access, Sedative or analgesic medications not intended for general anesthesia, Dexmedetomidine versus other sedatives or analgesics, Sedative/opioid combinations (all routes of administration), Benzodiazepines combined with opioids versus benzodiazepines, Benzodiazepines combined with opioids versus opioids, Dexmedetomidine combined with other sedatives or analgesics versus dexmedetomidine, Dexmedetomidine combined with other sedatives or analgesics versus other sedatives or analgesics (alone or in combination), Intravenous versus nonintravenous sedative/analgesics not intended for general anesthesia (all non-IV routes of administration, including oral, nasal, intramuscular, rectal, transdermal, sublingual, iontophoresis, nebulized), Titration versus single dose, repeat bolus, continuous infusion, Sedative/analgesic medications intended for general anesthesia, Propofol alone versus nongeneral anesthesia sedative/analgesics alone, Propofol alone versus nongeneral anesthesia sedative/analgesic combinations, Propofol combined with nongeneral anesthesia sedative/analgesics versus propofol alone, Propofol combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Propofol alone versus other general anesthesia sedatives (alone or in combination), Propofol combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Propofol combined with other sedatives intended for general anesthesia versus propofol (alone or in combination), Ketamine alone versus nongeneral anesthesia sedative/analgesics alone, Ketamine alone versus nongeneral anesthesia sedative/analgesic combinations, Ketamine combined with nongeneral anesthesia sedative/analgesics versus ketamine alone, Ketamine combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Ketamine alone versus other general anesthesia sedatives (alone or in combination), Ketamine combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Ketamine combined with other sedatives intended for general anesthesia versus ketamine (alone or in combination), Etomidate alone versus nongeneral anesthesia sedative/analgesics alone, Etomidate alone versus nongeneral anesthesia sedative/analgesic combinations, Etomidate combined with nongeneral anesthesia sedative/analgesics versus etomidate alone, Etomidate combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Etomidate alone versus other general anesthesia sedatives (alone or in combination), Etomidate combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Etomidate combined with other sedatives intended for general anesthesia versus etomidate (alone or in combination), Intravenous versus nonintravenous sedatives intended for general anesthesia, Titration of sedatives intended for general anesthesia, Naloxone for reversal of opioids with or without benzodiazepines, Intravenous versus nonintravenous naloxone, Flumazenil for reversal or benzodiazepines with or without opioids, Intravenous versus nonintravenous flumazenil, Continued observation and monitoring until discharge, Major conduction anesthetics (i.e., neuraxial anesthesia), Sedatives combined with regional anesthesia, Premedication administered before general anesthesia, Interventions without sedatives (e.g., hypnosis, acupuncture), New or rarely administered sedative/analgesics (e.g., fospropofol), New or rarely used monitoring or delivery devices, Improved pain management (i.e., pain during a procedure), Reduced frequency/severity of sedation-related complications, Unintended deep sedation or general anesthesia, Conversion to deep sedation or general anesthesia, Unplanned hospitalization and/or intensive care unit admission, Unplanned use of rescue agents (naloxone, flumazenil), Need to change planned procedure or technique, Prospective nonrandomized comparative studies (e.g., quasiexperimental, cohort), Retrospective comparative studies (e.g., case-control), Observational studies (e.g., correlational or descriptive statistics). 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