Authors (including presenting author) :
Chan AKM(1), Fung KY(1), Ho MF(2), Tam TH(2), Chan SY(1), Ma CH(1), Tsung PPK(1), Chuen YTJ(1)
Affiliation :
(1)Department of Anaesthesia and Intensive Care, Prince of Wales Hospital (2)Department of Surgery, Prince of Wales Hospital
Introduction :
Since publication of Guidelines on Procedural Sedation by the Hong Kong Academy of Medicine, the focus on sedation safety is a key area for quality improvement and patient safety across HA. With increasing complexity of patients requiring procedural sedation without presence of anaesthesiologists, it is imperative to enhance safe sedation practices amongst frontline staff. To date, there has been no published risk stratification tool nor well-established workflows in this regard. A multidisciplinary taskforce in PWH including anaesthesiologists, surgeons and perioperative nurses established a novel risk stratification tool and workflow to identify high risk patients, and enhance monitoring and staffing accordingly. Between July and December 2022, ESSLA was piloted amongst hernia repair patients under local anaesthesia requiring sedation in PWH.
Objectives :
1. Evaluate effectiveness of ESSLA in risk stratification and enhancing safety in procedural sedation 2. Evaluate ease-of-use of ESSLA amongst operating theatre staff 3. Evaluate confidence of operating theatre staff in providing sedation safely with ESSLA
Methodology :
After literature search and expert input, a risk assessment tool was designed to stratify patients’ risk for procedural sedation preoperatively – to aid surgeons and nurses identify/triage high risk patients. Based on risk, specific recommendations were made for titration of sedation, monitoring and staffing. An antidote box with cognitive aids to guide monitoring and resuscitation were also developed. Surveys were sent out 6 months after piloting for evaluation.
Result & Outcome :
Between July and December 2022, 29 LA hernia cases requiring sedation were performed, of which 28% were intermediate-to-high risk. There were no adverse sedation-related events in all cases. 52 perioperative nurses and 10 surgeons responded the survey. >80% of nurses and 100% of surgeons agreed that ESSLA was useful and easy-to-follow for screening and risk stratification preoperatively. >93% of nurses and 100% of surgeons agreed ESSLA was useful and easy-to-follow intraoperatively. >76% of nurses and 100% of surgeons agreed that the tool enhanced confidence in risk stratification and procedural sedation, while >87% of nurses and 100% of surgeons agreed that ESSLA has enhanced sedation safety. The success of the pilot program proved that ESSLA can be extended to other procedural sedation cases under LA.
