A risk management audit: are we complying with the national guidelines for sedation by non-anaesthetists?

• Published in: Emergency medicine journal : EMJ Vol. 16; no. 2; pp. 120 - 122
• Main Author: Nicol, M F
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.03.1999; BMJ Publishing Group LTD
• Subjects: Conscious Sedation - standards; Conscious Sedation - trends; Emergency Service, Hospital - standards; Guideline Adherence; Humans; Medical Audit; Monitoring, Physiologic - standards; Monitoring, Physiologic - trends; Nurse Anesthetists; Pain - drug therapy; Pain - etiology; Practice Guidelines as Topic; Risk Management - standards; Risk Management - trends; Shoulder Dislocation - complications; Shoulder Dislocation - therapy; United Kingdom
• ISSN: 1351-0622; 1472-0205; 1472-0213
• DOI: 10.1136/emj.16.2.120

OBJECTIVES: To assess the effect of a preprinted form in ensuring an improved and sustained quality of documentation of clinical data in compliance with the national guidelines for sedation by non-anaesthetists. DESIGN: The process of retrospective case note audit was used to identify areas of poor performance, reiterate national guidelines, introduce a post-sedation advice sheet, and demonstrate improvement. SETTING: Emergency Department, Musgrove Park Hospital, Taunton. SUBJECTS: Forty seven patients requiring sedation for relocation of a dislocated shoulder or manipulation of a Colles' fracture between July and October 1996 and July and October 1997. MAIN OUTCOME MEASURES: Evidence that the following items had been documented: consent for procedure, risk assessment, monitored observations, prophylactic use of supplementary oxygen, and discharging patients with printed advice. Case note review was performed before (n = 23) and after (n = 24) the introduction of a sedation audit form. Notes were analysed for the above outcome measures. The monitored observations analysed included: pulse oximetry, respiratory rate, pulse rate, blood pressure, electrocardiography, and conscious level. RESULTS: Use of the form significantly improved documentation of most parameters measured. CONCLUSIONS: Introduction of the form, together with staff education, resulted in enhanced documentation of data and improved conformity with national guidelines. A risk management approach to preempting critical incidents following sedation, can be adopted in this area of emergency medicine.