Conscious Sedation & JCAH

[toolanator]

We just had a visit from JCAHO, we did ok no major problems, but the surveyors really keyed in on charting vital signs during an endoscopy procedure w/conscious sedation. we always check vital signs before we begin sedation and then every 5 minutes during the procedure. they wanted to see vital signs every one to two minutes during the onset of sedation. has anyone else been told this? or does anyone do vital signs every one to two minutes during onset of conscious sedation, and if you do what is your cutoff time for onset of sedation or does that include the entire time you give any sedation. i'd love to know what other folks are doing out there. Thanks :kiss

[babsRN]

It has been my understanding as well that the standard v.s. interval during IVconsed. is q5 min as long as the patient is stable. One resource you might check is the ASA to see what their standard of practice currently is. It has been q5 in the past, it may have changed. What does your policy say? Sometimes JCAHO likes to ding you if your practice doesn't match your policy statement. Anything more frequent than q5 min on a stable patient(ASA class I, II, or III)with a routine procedure seems like overkill to me. I have about 6 years precedural experience(GILab/Radiology special procedures, etc)

Keep me posted as I'm currently getting more involved in the management aspects of the cath lab world and would love updates from you or anyone else out there...good luck

[MLL]

Hi toolanator,

I am also an Endo RN. We get a baseline, then monitor the patient q 5 or 10 minutes, depending upon the nature of the procedure, i.e. Sig, Colon, EGD, Bronch, ERCP. Obviously, if the patient is unstable, or highly advanced in years with multiple health problems, common sense dictates that you monitor more frequently. Our policy states VS q 5 - 10 minutes throughout the procedure, unless unstable.

Joint Commission is looking for consistency between your policy and your documentation. Have you assessed thoroughly pre, intra, and post-procedure (allergies, H & P, ASA scores pre and post, etc.) IV access until discharge, reversal drugs ready and available, emergency equipment ready and available, airway and B/P management with all equipment available, and the list goes on, and on, and on, and on.

If documention on the patient record shows evidence of continued assessment, education, diagnosis, outcome identifications, planning, implementation, and evaluation of patient care, and these are all consistent with your hospital's policies, you should be O.K. with JC. Providing of course the policies make sense.

Pain assessment is a big one which we will be working on this year, as we have heard through the grapevine Joint will be concentrating on it in a big way.

Another big question is care plans for ENDO, with all the procedures we do, and all the potential patient complications that might arise.

Have a good one!

[babsRN]

Good point about the plan of care. At my last hospital where I got most of my procedural experience, we developed pre, intra, and post procedural plans of care, in such a way that they could be applied to each procedure and the nurse could just check off the items that pertained to the patient, as well as select the appropriate goals for a particular patient. It worked out really well and didn't interfer with the plan of care for those patients who were currently or about to become inpatients.

[BRobison]

for those of you looking for guidelines on IV conscious sedation, you might want to check with the AANA (American Association of Nurse Anesthetists). Their information is very helpful.

BMR, RN, CRNA

[Fletcher]

Our last JCAHO visit validated that q5Min vitals is acceptable during IV Con Sed.

Wendy

[nrw350]

Hmm, I had always wondered how often they took my vitals at the oral surgeon. The problem is I only remember once or twice lol. But we all know why my memory of the procedure is almost non-existant lol.

Nick

[meandragonbrett]

I have a question for you guys. Tell me what the proceedure is at your hospital.

Our ODSU takes all surgeries, lithotripsys, and GI cases. What is your policy for transportation of lithotripsy patients? Our policy has recently changed from CPR certifited techs transporting all lithos. to RN's must transport with a crash cart if sedation has been within 30 minutes or if any drugs were given during the procedure b\c not all of the patients want\need sedation. I was just wondering what your policy is.

Brett

[ERQueen]

Anesthesia checks q 3 min during procedures where they are administering. Our policy in the ER is to check q 5 min as minimum. We check after every drug administration sequence, which I guess would end up being ever 2-3 minutes during onset. Most of our conscious sedations are for ortho purposes, so we also check vitals after any big event, like a long pulling of the shoulder, or when the affected limb is reduced.

[Alley Cat]

Another question: Do any of your facilities differentiate between adult and pediatric procedural sedation? Our facility has decided to write one policy for both populations, says there's no difference. My position is that kids are not little adults; the form we used previously on peds had an area on the H&P part of the form for immunization status, recent exposures (e.g., chickenpox), etc. Things that pertain to kids. On the form we're now using regardless of age, there's no room for any of that.

My handwriting is bad enough without cramping my space!