Moderate sedation

[sameasalways, ASN, RN]

Anyone do moderate sedation? I have recently been nominated to be on the moderate sedation committee where I work. I wondered what your yearly check-off consisted of and what your training consisted of in order to do moderate sedation?

I am very concerned about these issues as are the other nurses I work with. Most of us I feel had somewhat lousy training on it. I don't want to say that and make anyone look bad, but as a whole, I do not think our facility has been very organized about training or preparing nurses to do this.

We are expected to understand the anesthesia cart...this is what we are using to monitor the pts O2, respirations, heart rate, and BP on the anesthesia cart. This is done in one of the OR's or the procedure room, and each anesthesia cart is a little bit different in each room. Also, we are not familiar with the OR and procedure rooms in terms of where every single item is...like a tongue depress or , or face mask, etc. We are now having to start doing moderate sedation down in Radiology too, so they do not always have everything we need, plus we do not have access to the Pyxis there.

I began bringing my own items to the room to prevent scavenging in a time of need. Not every nurse does this. We only do moderate sedation about once a week, and each nurse must rotate through. This means you only do it about once every 4 weeks, sometimes longer in between.

We had a situation come about where an ICU charge nurse was teaching a floor nurse how to do it, and it was discovered they did not have the reversals pulled or any O2 nasal cannula available.

I want to make sure we are all safe, and any info others have is appreciated.

[azhiker96, BSN, RN]

The only nurses I've seen doing moderate sedation are CRNAs. In general, you need to be able to rescue a patient from one level above what is planned. Patients will react differently to the same dose of the same Med. Check the nurse practice act for your state and see if the BON has any practice recommendations. This sounds like an event looking for a place to happen.

The only times I've sedated a patient was with a physician present and then it was not intended. He was trying to get the pt more comfortable but she ended up apneic. Things ended well after a little BVM action and a touch of flumazanil.

[brownbook]

I don't have a copy of our yearly test we take. At my old job we had a detailed 20 + page manual we studied and were tested yearly. At my current job we just take a yearly multiple choice written test. I had to observe and be observed for 10 cases by a certified nurse prior to doing moderate sedation.

All your concerns and questions are very appropriate. But I think bottom line any moderate sedation nurse, and any anesthesiologist, has to take the responsibility to check their room and equipment prior to sedating any patient. It doesn't matter if they have been doing anesthesia 40 years in the same facility, or are a newly certified RN doing moderate sedation. You must physically go to the room, clinic, area, where you will be doing the sedation prior to the patient being brought there and see where equipment is, is it working, are the drugs I need here. If not familiar with a monitor or any equipment the case doesn't start until someone shows you how it works.

I don't think that has ever been stressed in all my moderation classes or tests but that is the most critical thing a sedation nurse or MD must do.

[sameasalways, ASN, RN]

Thank you! The requirement here is taking a moderate sedation CBL. We do moderate sedation on the weekly here, but like I said, it rotates through each nurse.

We do moderate sedation for radiology procedures, bronchoscopes, Pain injections mainly. But also pacemaker implants and AV fistula placements.

We have a policy from regional, and it says that each moderate sedation nurse must complete a yearly competency, but it doesn't state what the yearly competency is.

Where I used to work, the nurses who did it had to be checked off and go to a class once a year where they were checked off and take a test.

I am not happy with this facility in general because of their loose tendency to follow policy. I do not feel safe doing moderate sedation here, but they have put me on the committee and I am hoping to make it better without insulting anyone.