Moderate Sedation policy

[RadRN2]

What's everybody's P&P for doing moderate sedation in particularly MRI? At my hosp., our policy has been reworked a million times but is still very frustrating and confusing! We are being told that it is a JCAHO requirement for a physician "to be in constant visual sight of the patient during initial and continued administration of meds" during moderate and deep sedation of patients. Generally not a problem because this often occurs during procedures that the Rad is there, anyway. But, when we need to sedate an adult for MRI who has failed oral sedation and needs IV meds, there is NO WAY the Rad wants to sit right there with us for a 30 min - 2 hr scan. We are considering having anesthesia do all these cases if we must comply with this statement. But, to us Rad nurses, it seems like an expensive overkill when we all are trained and feel comfortable with controlling moderate sedation WITHOUT the Rad having to be right there the whole time. What are you all doing? How do you feel about this, if it truly is a JCAHO requirement?

Thanks!

[dianah, ASN]

If the adult pt failed oral sedation we arrange for anesthesia. We don't have the staff to sedate.

Most peds are done w/anesthesia (unless it's, say, a 13-yr-old who can cooperate and is cool w/the exam).

[NurseGirlKaren]

We have anesthesia do sedated MRI's. They usually intubate and put them on a propofol drip, so they don't have to stay in the room. Then we recover the pt.

[radblt]

In the facility where I work, we do both pedatric and adult moderate sedations. The requirement is that the radiologist has to be present in the department while the sedation is going on. The radiologist is usually in the reading room located near the scanners. Of course, he must assess each patient prior to the sedation as well as write the orders needed for the procedure. Very rarely do we come across an adult that needs true moderate sedation. Most of the time anxiolysis will do. It is often given in the IV form--Valium, Ativan, or Versed (alone). Pedatric patients under 2 are usually sedated with oral Chloral Hydrate at 75mg/kg up to a max of 125mg/kg. Children over the age of 2 normally receive IV Versed, and Nembutal (2mg-7mg/kg titrated). Adults requiring moderate sedation usually receive Versed and Fentanyl IV. I hope that this is helpful!:)

What's everybody's P&P for doing moderate sedation in particularly MRI? At my hosp., our policy has been reworked a million times but is still very frustrating and confusing! We are being told that it is a JCAHO requirement for a physician "to be in constant visual sight of the patient during initial and continued administration of meds" during moderate and deep sedation of patients. Generally not a problem because this often occurs during procedures that the Rad is there, anyway. But, when we need to sedate an adult for MRI who has failed oral sedation and needs IV meds, there is NO WAY the Rad wants to sit right there with us for a 30 min - 2 hr scan. We are considering having anesthesia do all these cases if we must comply with this statement. But, to us Rad nurses, it seems like an expensive overkill when we all are trained and feel comfortable with controlling moderate sedation WITHOUT the Rad having to be right there the whole time. What are you all doing? How do you feel about this, if it truly is a JCAHO requirement?

Thanks!

[smittybike]

We have worked closely with the Anesthia dept to work out the specfics for our MRI sedation. The pt must have a physical and screening, bring a list of meds and be npo for 6 hrs. Consious sedation up to level 3 is premissiable with proper monitoring. Our understanding is that the physican needs to be in the department, and aware of the sedation going on that he/she is ordering.

[dspring, RN]

We do Con Sed in our MRI unit, and the Rad has to be ppresent during the procedure,, and it can tie him up for awhile. We resort to anest. occasionally also.