Need conscious sedation standing orders

[buffyohara]

I know it is vertboten to call it standing orders, but that is essentially what I am trying to create. I want to know how you all handle obtaining orders for sedation during procedures. I think an order sheet filled out b4 the case specifying what and how much should be given is a winner but dept head disagrees. If you have writen protocols, could you send them to me via a private message. thanks

[GeanineRN]

I to have found this area very difficult. There is no protocal that I am aware of. This comes from the physicians personal preference, the patient, and department of anesthesia. Age, physical illness, patient size, etc play a role in how much medication to use.

Talk with the physician first, get his preferences and guidelines.

In a fairly healthy patient, under 70 years old, I start with Versed 1-2 mg, and Fentanyl 50 mcg IVP. Wait 2 minutes and give more if needed. If patient is > 70yo, I start with Versed 1 mg, and Fentanyl 25 mcg, until I see how they respond. Follow your anesthesia guidelines for conscious sedation medications and dosing. Remember that these are only guidelines, and that the physician is ultimately responsible for how much or little is given.

I love giving Fentanyl because of the short half life. 15 - 30 minutes.

I find that they are pretty awake when they get off the table, and can go home faster. IV Morphine lasts 2-3 hours, which is great for painful procedures, but I like to do this postop.

Remember that Versed is only good for sedation, not pain management. Some patients may be sedated, and not be able to tell you if they hurt. So if it's a painful procedure, permcath insertions, etc. I always give narcotics.

Something I recently learned also, is that patients on anti-seizure medications, are very difficult if not impossible to sedate. If you've had this experience before, and this patient comes back, you might want to consider anesthesia department. They can use diprovan, with fentanyl, and this works great!. Our department of anesthesia, will not allow us to use diprovan in our department.

[dianah, ASN]

For cath lab, when the MD does the "time out" and the airway assessment, we automatically inquire for a first dose of Versed (which is usually 1mg IV). If we are concerned about sedating the pt (say, baseline BP is 84/60), we bring up our concerns then, and we (the MD and the nurse(s)) usually agree when and with what to sedate.

What you seem to want is practice guidelines. Perhaps an inservice given by someone in your anesthesiology dept who has broad moderate sedation experience . .??

I believe your dept head is being wise in nix-ing the written "standing orders." Sedation orders should be individual, and arrived at after a thorough review of the patient's chart, history, and an interview with that pt. Standing orders as you've described them, can introduce doubts that the pt was assessed, giving the impression that the orders were simply signed, with the pt unseen. It's a safety thing, I think.

Geanine gave some very good information, too. I tend to sedate much like she does. :)

Good luck! :)