Protocols for discharging patients who have sedation

elliej · Nov 25, 2004

Well I'm in Maryland and in our center we have an anesthesiologist give the meds. (Propofol, versed, fentanyl) and we only keep the patients 20 to 30 minutes afterward.

Ellie

mshultz · Nov 26, 2004

Quoting from my discharge instructions:

1. The medication that you were given prior to the procedure will alter your reaction time. Even though you feel normal it is very important that someone drive you home. You are advised to rest and relax for 24 hours.

2. After the examination start with easily digested foods and slowly progress to your regular diet. Your appetite should return to normal in 12 to 24 hours.

3. Do not drink alcoholic beverages for the next 24 hours. Alcohol enhances the effects of sedation.

As you can see, there is no mention about any kind of supervision after discharge. What about patients who have no one to watch after them? Are they kept at the hospital overnight, is a nurse sent to their home to watch them overnight, or is the procedure cancelled?

I hope that there are provisions for these patients without someone to watch over them. To do otherwise is in effect "blaming the victim".

alanpe · Nov 27, 2004

I assume what one says before:

[highlight]1. The medication that you were given prior to the procedure will alter your reaction time. Even though you feel normal it is very important that someone drive you home. You are advised to rest and relax for 24 hours.

2. After the examination start with easily digested foods and slowly progress to your regular diet. Your appetite should return to normal in 12 to 24 hours.

3. Do not drink alcoholic beverages for the next 24 hours. Alcohol enhances the effects of sedation. [/highlight]

So i just want to add a litle more:

Many times the endoscopy is done to illness in hospital that is treated of other patologies, eg alcohol consumers, alcohol can affect many people:

dependence, stomac and digestive problems, etc.

So it is possible interactions with other drugs like other benzodiazepines, theses benzodiazepines interact and enhance to each other; if you are a registered nurse,as long as you shot many time all kind of benzodiazepines like midazolam.will know benzodiazepines are administrated to treat to alcohol dependence.

This situacion [highlight]"posible interactions" can happen to anyone[/highlight], so I think an endoscopy must be followed in a hospital, at least one or two days, if not a nurse should watch the patient.

It is just my opinion.

alanpe

kimtab · Nov 29, 2004

This situacion [highlight]"posible interactions" can happen to anyone[/highlight], so I think an endoscopy must be followed in a hospital, at least one or two days, if not a nurse should watch the patient.

But this is why we ask people for their current medications, drug allergies, health history, substance use, etc. If you want to require a 1-2 day hospital stay for an otherwise healthy person who is getting scoped, insurance isn't going to pay for it and patients aren't going to go for it either.

suzanne62 · Nov 29, 2004

I worked in endoscopy in the uk and most of what you have said applied. If they had no one to stay with them they were kept in over night or cancelled.

I now work in New Zealand and they don't seem to worry about that here as long as you have some one to take you home.

:balloons:

alanpe · Nov 29, 2004

I was referring to a private hospital, insurance firms care not only for the illnes people, they care for their accionists too.

Like Suzanne said bellow I think is a good choice to public health:

[highlight]"you have some one to take you home"[/highlight]

Trauma Columnist · Nov 29, 2004

Here in Illinois - you are sedated for endoscopy and then sent home within 2 hours. You have to have a person take you home though. However, we do conscious sedation or moderate sedation as it is now called and send people home within two hours all the time. Again...with an adult giving them a ride.

alanpe · Nov 29, 2004

[highlight]"In Illinois - you are sedated for endoscopy and then sent home within 2 hours. "[/highlight]

In Illinois, who person is in charge wether it hapened some endoscopy complications or not? Must the patient sign the informed consent?

ibnrn · Dec 9, 2004

We monitor patients for minimum of 30 minutes after their procedure and send them home. A "responsible adult" has to sign a paper that the patient will not be allowed to drive, make important decisions, or drink alcohol for 24 hrs. after the procedure. As far as what happens after the patient leaves, we have no control over that. If the patient has significant medical problems, we will sometimes keep them overnight; however, the bed situation at our hospital is so tight (only 33 inpatient beds) that we cannot always do this!

TZT · Mar 5, 2005

Hi Everyone.
I dont know if this has been discussed, but i would to hear what other endoscopy units, all over the world, do with discharging patients who have had sedation.
In the UK in the unit i work in, any patients receiving a sedative (we use Midazolam), must have overnight supervision for minimum 24 hours.
I would love to her what other units do

I work in the Endo dept. in an upstate NY facility. We keep pts an hour form the last time they were medicated. We also have them sign their discharge papers prior to being medicated that states they will have someone to drive them home. We use Demerol and Versed in the smallest affective dose possible. The duration on these drugs are short acting, 2-4 hours for Demerol and depending on the dosage for Versed 1-5 hours. Some responsibility has to be placed on the pt for their own health and well being. They way hospital are run today, like a business, theres no way we could possibly keep people in over night. That is saved for the pt that needs it.:)

MizLisa · Mar 5, 2005

:rolleyes: hello in the unit i work in in southern california we can discharge pts after being in recovery for 1/2 and their vital signs are within a normal range of their baseline. we also require pts to pass the air from the colonoscopy and have a soft non tender abdomen and to be able to swallow without and pain or difficulty after an egd. we use demerol and versed. usually the average does is 50mg demerol 3-4 mg of versed per pt. that is the average. sometimes less and sometimes more. we are also seeing a trend of pts (especially men) having a colonoscopy without and sedation. they leave after they pass the residual air from the procedure. a 24hr stay is excessive and versed is pretty much metabolized in about 20 mins. good luck! lisa

hi everyone.
i dont know if this has been discussed, but i would to hear what other endoscopy units, all over the world, do with discharging patients who have had sedation.
in the uk in the unit i work in, any patients receiving a sedative (we use midazolam), must have overnight supervision for minimum 24 hours.
i would love to her what other units do