Evaluating Patient's Chart To Moderate Sedation Process

The nursing director, chief of surgery, and medical director for the O.R. are responsible for developing a policy that meets the needs of the current facility. Nursing, anesthesia, and surgical staff should have input into the policy. The policy change should be approved by hospital administration.

Also, by properly conducting a time-out session where the patient is provided with a standardized briefing prior to the patient is sedated in the OR could also eliminate some the sentinel or adverse events in the OR. Furthermore, follow a checklist, which not only pertains to the surgery itself, but also focuses on the other procedures involved such as admissions, anesthesia equipment, and discharge (Mulloy & Hughes 2008).

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Lack of enough trained staff in conscious sedation available at the time of the procedure

To do so, I am going to use the fishbone diagram to categorize the causative factors (Potter & Perry, 2008).   For patient characteristics, Mr. B was a 67 year old patient with routine use of oxycodone to treat chronic pain.  Because of his routine use of oxycodone, he may need a different dose to get to a sedated level than other people who are not on any medication.  Next is the task factors, the hospital had a policy which requires that anyone who are treated with moderate sedation or analgesia have to be put on continuous blood pressure, ECG, and pulse oximeter monitoring until the procedure is done and patient is in stable condition.  Mr. B was not being monitored accordingly during the sedation process.  Another task factors is that all staffs must first complete a training module on sedation before performing the task.  Individual staff is a factor too, Nurse J had completed the training module on sedation, he had an ACLS certification as well as experience working as a critical care nurse.  Team factors include communication between staffs; an example would be the LPN not informing Nurse J or Dr. T when the alarm went off the first time, it showed that Mr. B had low oxygen saturation.  Work environment factors included the staffing in the ER, the equipments they had, and the level of experience of the staffs.  According to the scenario, additional staffs were available for back up support and all the equipment needed

day to day against what was set out in the PEP and liaise with other professionals to update and seek guidance. At a follow up PEP the warren and attending professionals will look back at the goals set and assess where progress has been made and set new goals if applicable.

In preparation of a review from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Nightingale Community Hospital will focus on improving its communication process in the operating room. The purpose of communication in the healthcare setting is to disseminate information in such a way as to create shared understanding about the patient and about what needs to be done for a positive outcome. (synergia.com) A patient is at his most vulnerable state during procedures that require sedation or anesthesia. The patient is releasing his decision making ability and safety into the control and care of the healthcare team. Therefore, effective communication on behalf of the patient is

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

The second part of The Model for Improvement is the PDSA cycle. This is the testing phase of the model. The acronym PDSA stands for Plan, Do, Study, and Act. This is a four step process which is a simple way to test and make changes to the process. If The Model for Improvement is applied to Mr. B’s scenario, the aim of the improvement plan would be to make sure that patients coming into the emergency room receive the appropriate dose of medications, that the patients are monitored correctly, and that the staff is educated about proper medication administration. The measures part, How will we know a change is an improvement, could be answered by compiling data with the number of patients receiving hydromorphone in the emergency room, what type of monitoring was used

sedation have continuous BP, ECG, & Pox monitoring done. Nurse J. who was trained in the

However, if the manager of this department sees improvement and would like too, she can recommend this process to other departments throughout the hospital. This could possibly lead to a positive impact on the hospitals overall score in patient

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period? The available data supported the hypothesis that nursing education and competency can lead to consistent best practices and positive outcomes for patients. The answers to this research question can help develop interventions that support best practices for patients who are mechanically ventilated and receiving intravenous sedation.

To establish a change that transforms the patient bedside care an initiative model was establish the Transforming Care at the Bedside (TCAB), this model consisted of four categories to measure the patient care, the

The complete process required thinking, planning and organizing. Once these steps are completed, the program gets easier to manage. I think that this program allows me to learn and create care procedures for the future to complete my patient care on a timely basis.

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and