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  • Cited by 1
  • Print publication year: 2012
  • Online publication date: March 2012

Chapter 7 - Quality, legal, and risk management considerations: ensuring program excellence


The modern practice of sedation is the end result of a process of evolution in alteration of consciousness, likely starting with the discovery of the analgesic properties of ether. Recent technological advances have drastically changed the practice of sedation. One of the most significant was certainly the development of pulse oximetry during World War II by Glen Millikan. In 2002, the American Society of Anesthesiologists (ASA) appointed a task force to update practice guidelines for non-anesthesiologists administering sedation and analgesia. The Association of periOperative Registered Nurses (AORN) has produced guidelines for what every registered nurse should know about "conscious sedation". According to the AORN, moderate sedation/analgesia is produced by the administration of amnesic, analgesic, and sedative pharmacologic agents. With continued attention to a high standard of safety, many different professionals are able to provide sedation services to those patients who need them.


1. Restatement (Second) of Torts, §282 . 1965.
2. Massachusetts Board of Registration in Medicine. Policy 94–04 . Patient Care Assessment Guidelines for Intravenous Conscious Sedation.
3. Massachusetts Board of Registration in Medicine regulation 243 CMR 3.00 .
4. Centers for Medicare and Medicaid Services (CMS) . Conditions of participation: regulations at 42 CFR 482.
5. American Society of Anesthesiologists (ASA) . Statement on granting privileges for deep sedation to non-anesthesiologist sedation practitioners. Park Ridge, IL: ASA, 2010.
6. American Society of Anesthesiologists (ASA) . Statement on granting privileges for administration of moderate sedation to practitioners who are not anesthesia professionals. Park Ridge, IL: ASA, 2006. (accessed June 2011).
7. Metzner J , Domino KB. Procedural sedation by nonanesthesia providers. In Urman R , Gross W , Philip BK , eds., Anesthesia Outside of the Operating Room. Oxford: Oxford University Press, 2011; 49–61.
8. Joint Commission. Provision of care, treatment and services standards, record of care, and improving organizational performance . In Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission, 2011.
9. University HealthSystem Consortium Consensus Group on Moderate Sedation . Moderate Sedation Best Practice Recommendations. Oak Brook, IL: UHC, 2005.
10. University HealthSystem Consortium Consensus Group on Deep Sedation . Deep Sedation Best Practice Recommendations.Oak Brook, IL: UHC, 2006.
11. Mahajan RP. Critical incident reporting and learning. Br J Anaesth 2010; 105: 69–75.
12. Vincent C , Taylor-Adams S , Stanhope N. Framework for analysing risk and safety in clinical medicine. BMJ 1998; 316: 1154–7.
13. Massachusetts Department of Public Health regulation 105 CMR 130.332 , Serious reportable events.
14. Massachusetts Department of Public Health regulation 105 CMR 130.331 , Serious incident and accident reports.