Authors (including presenting author) :
CHOW UU, LEE CF
Affiliation :
Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital
Introduction :
The Hong Kong Academy of Medicine has updated the “Guideline on Procedural Sedation” in 2020, and highlighted on trained staff during procedural sedation and use of capnography. Regular review and monitoring are required to ensure safe sedation procedures in order to have early detection of adverse drugs effects on patients. However, use of capnography for procedural sedation in Operating Theatre, Queen Elizabeth hospital (QEH) is evaluated and brought up into a routine practice.
Objectives :
Aim: To enhance patient’s safety on procedural sedation through the establishment of
a reliable system for monitoring patients in the absence of anesthetists.
Objectives:
To enhance patients’ safety by introducing the use of sedation scoring system
(modified Brussels Sedation Scale) and capnography monitoring on local
anesthesia cases.
Methodology :
Pilot study on monitoring end-tidal CO2 and sedation level was firstly introduced in May 2021 in QEH Operating Theatre (OT). A new sedation scoring form and workflow in Intravenous (IV) sedation for Local Anesthesia (LA) case were established. “Modified Brussels Sedation Scale” ranged from 1 to 5 was chosen to document the sedation level, and set up the criteria in using capnography with a procedural sedation form document the care from Intra-procedure to post-procedure care.
Training sessions for OT staff about procedural sedation safety were conducted. In addition to our usual practice of physiological monitoring, nursing staff are required to assess the patients’ sedation score and the corresponding nursing intervention during the procedures. The sedation level also reminds them to use the capnography device to monitor patient's ventilation level when oxygen therapy is given.
Result & Outcome :
Results: As a snapshot, from September to November 2022, total 53 samples with procedural sedation were conducted in QEH OT. Among these cases, 38 were cystoscopic procedures, 12 were angioplasty and 3 cases of Tenckhoff catheter related procedures. With the implementation of the new workflow and devices, 97% of patients successfully underwent sedation assessment. 33% (17 cases) developed a decrease in conscious level after sedation. Among the patients with decreased conscious level, 73% (12 cases) dropped in end tidal CO2. As an early detect of abnormal, appropriate interventions are given timely.
Conclusion: In order to keep our nursing care abreast to the standard which is required by the latest version of Guideline on Procedural Sedation, we set up and modified the sedation scoring system for assessing patient sedation level; and introduced the use of the capnography device to monitor end-tidal CO2 for monitoring sedated patients’ ventilation during surgeries. Hypoventilation can be detected immediately by capnography, while pulse oximetry takes time to detect such problems. Using capnography to monitor end-tidal CO2 can early detect any respiratory complications and improve the patient safety. The sedation scoring system and capnography monitoring were effective in providing subjective and objective information for us to provide timely nursing care to patients receiving intravenous sedation. The new practices are proven to safeguard sedated patients during their perioperative journey.
