Hi...Today was my 2nd day at new job in GI. It was my 1st day in procedure, with a nurse and observing and assisting with the cases..mainly learning how they do things, and the paperwork aspect of it.
I have lots of concerns.
The patient acts like they are asleep.. They seem more like deep sedation than moderate sedation, is this normal....they once in a while wince if they get more awake. And then they are given more Fentanyl and Versed. Like I said, I am not familiar with doing these types of cases for moderate sedation. When we did moderate sedation at the hospital, the pt was much more alert and responsive. I have never done moderate sedation for upper/lower GI cases, so I am not sure if this is typical.
Also I was told the pt can't leave the procedure room if they aren't an aldrete of 9 or above. The nurse said they had to have 3 vitals of the pt on RA (done every 3 min) before the pt can be brought out..so she stops (they all probably do) stop the O2 at the beginning of the procedure for Egd . (so the pt can be brought out almost immediately to the recovery area.
The dr writes an order for the mod. sedation at the beginning of the case that says what to give, then he steps out of the room until the pt is asleep and the tech is sent to get him/her. Once it has been 3 minutes, whether the dr is in the room or not, they are pushing 25 Fentanyl with 1 Versed every 3 minutes until the pt is "asleep". They maintain this until the dr reaches the cecum. They like to stop then, so that the pt will be awake and able to roll out of the procedure room once the procedure is over...and that way they will usually have been on RA x 3 sets of vitals as well, once the procedure is over.
The doctor then signs the order on the sheet where the nurse writes down what was given...and we are told to circle the "verbal order" part written under each section where we write what was given, when.
I voiced my concerns about not having actual orders and was told it is their policy.
Is this all reasonable? I would like to see the actual policy but I have yet to see ONE.
Disturbingly, the GI doc said they do ASA 3, ASA 4 all the time with RN moderate sedation. Where I used to work, that was a big no-no.
For the record, my new position is at a military outpatient GI clinic; my last job was at a small community hospital in the PACU and Pre-op area. We did moderate sedation on pain patients and bronchoscopes and some AV grafts or pacemaker implant. The patient obviously had local with some of these procedures, and they were far more awake.
