A descriptive monitoring study of a non-anesthetist sedation quality program

Rev Esp Enferm Dig. 2019 Jan;111(1):55-62. doi: 10.17235/reed.2018.5763/2018.

Abstract

Introduction: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications.

Methods: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy.

Results: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program.

Conclusions: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement.

MeSH terms

  • Adjuvants, Anesthesia / administration & dosage
  • Bradycardia / epidemiology
  • Clinical Protocols
  • Deep Sedation / adverse effects
  • Deep Sedation / standards*
  • Endoscopy, Digestive System / adverse effects
  • Endoscopy, Digestive System / methods*
  • Endoscopy, Digestive System / statistics & numerical data
  • Fentanyl / administration & dosage
  • Humans
  • Hypotension / epidemiology
  • Midazolam / administration & dosage
  • Middle Aged
  • Patient Safety
  • Program Evaluation*
  • Prospective Studies
  • Quality Indicators, Health Care
  • Quality of Health Care / standards*

Substances

  • Adjuvants, Anesthesia
  • Midazolam
  • Fentanyl