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6 - Federal and Hospital Regulatory Oversight in Emergency Department Procedural Sedation and Analgesia

from SECTION ONE - OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION

Published online by Cambridge University Press:  03 December 2009

John H. Burton
Affiliation:
Albany Medical College, New York
James Miner
Affiliation:
University of Minnesota
Sharon Roy
Affiliation:
Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, Email: sharon.roy@co.hennepin.mn.us
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Summary

SCOPE OF THE PROBLEM

Regulatory oversight of procedural sedation and analgesia (PSA) in the emergency department (ED) is multifaceted involving federal, state, institutional, and professional mandates (Figure 6-1). The stated goals of these regulatory bodies are patient safety, standardization of care, and clinical guidance.

Developing protocols can be challenging for organizations and practitioners when filtering recommendations from multiple regulatory agencies and practice disciplines. The reality for the ED practitioner is often an increased frustration owing to regulations that are often, simultaneously, restrictive yet general and broad. The ED is a unique setting that necessitates practice guidelines and procedures that are clear, yet flexible enough to meet the broad spectrum of situations encountered.

Although the need for consistency across organizations, practice disciplines, and departments may maximize patient safety, the square-peg-into-a-round-hole method of standardization will not work in the implementation of guidelines for sedation in emergency medicine. ED patients present with complex sedation needs, often complicated by concurrent diseases, hemodynamic instability, unpredictable NPO status, and untreated pain. Sedation in the ED is a specialized practice utilizing treatment approaches that are not common to other settings where procedural sedation is administered.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recently focused a great deal of attention on procedural sedation. Unfortunately, much of this attention had led to advisory materials that are not evidence based.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Godwin, SA, et al. Clinical policy: Procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005;45:177–196.CrossRefGoogle ScholarPubMed
Malviya, S, Naughton, NN, Tremper, KK. Sedation and analgesia for diagnostic and therapeutic procedures. St. Louis, MO: Humana Press, 2003.CrossRefGoogle Scholar
Lin, DM, Wightman, MA. Sedation, anesthesia and the JCAHO, 3rd edn, chapter 2. Marblehead, MA: HCPro, 2005, p. 4.Google Scholar
Comprehensive accreditation manual for hospitals: The official handbook. Standards for additional special procedures.
The Joint Commission on Accreditation of Health Care Organizations, Joint Commission Resources, 2007.
Emergency Nurses Association Position Statement 2006 Procedural Sedation and Analgesia in the Emergency Department, at www.ena.org, last accessed on January 2007.
Practice guidelines for sedation and analgesia by nonanesthesiologists. An updated report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Nonanesthesiologists. Anesthesiology 2002;96:1004–1017.

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