CONSCIOUS SEDATION: RN

TRAININGStephanie Ricketts

NURS 693

Spring 2015

OBJECTIVES Define sedations &

qualified providers

Discuss practice guidelines

Describe training at Kaiser

Examine CNS competencies utilized

DEFINTIONConscious sedation induces an altered state of

consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives.

Patients who receive conscious sedation usually are able to speak and respond to verbal cues throughout the

procedure to communicate any discomfort.

Minimal Sedation

Moderate Sedation

Deep Sedation

General Anesthesia

Qualified Providers Certified Registered Nurse Anesthetists (CRNAs) Anesthesiologists Physicians, dentists and oral surgeons Specifically trained registered nurses may assist in

the administration of conscious sedation

Practice Guidelines for Sedation and Analgesia by Non-

Anesthesiologists Approved by American Society of

Anesthesiologists

51 consultants from 17 specialties surveyed

1876 articles reviewed over 44 year period

Adopted by JCAHO

Practice Guidelines: Training of Personnel

“The healthcare facility shall have in place an educational/credentialing mechanism which includes a

process for evaluating and documenting the individual’s competency relating to the management of patients

receiving sedation and analgesia.” -AANA

“Each organization is free to define how it will determine that the individuals are able to perform the

rescue” -JCAHO 2009

RN Procedural Training at Kaiser Moanalua

Part 1: Online competency test

Part 2: “Hands on” training in OR

UNREALISTICGeneral

Anesthesia NOT procedural sedation

Sedation SimulationObjectives

1. Supplement online competency

2. Realistic & consistent training

3. Simulate dynamic decision making process used in procedural sedation

Progress thus far

Literature Review & data collection

Create/edit curriculum

Pilot Simulation

Evaluation

Simulation Scenarios

• Routine Patient• Allergic Reaction• Hypoventilation

• Abnormal Cardiac function

• Deterioration of Mental Status

✔

✔

Evaluation 1. Trial simulation posttest & survey

2. Nurse & Patient satisfaction surveys

CNS Competencies Utilized

Competency Sphere of Influence Nurse Characteristics Detailed Actions performed

Consultation Nurse & System Facilitation of Learning, collaboration & clinical

judgment

Initiated consultation with CRNAs & clinical

educators while collecting resources

Systems Leadership Nurse & System Collaboration & systems thinking

Determined nursing practice & system interventions to promote safety

Collaboration Nurse & System Clinical Inquiry & Collaboration

Collaborated with CRNAs, physicians &

RNs to ensure all needs are addressed in

training.

Coaching Nurse Facilitator of learning & clinical inquiry

Promoted professional development through

presentation & application of EB care

Research Nurse & System Clinical Inquiry, systems thinking

Analyzed research findings & other clinical facts for

potential integration to SIM

ReferencesAmerican Association of Nurse Anesthetists. Qualified Providers of Conscious Sedation Position

Statement 2.2. Park Ridge, IL: American Association of Nurse Anesthetists; 1996.

 

American Association of Nurse Anesthetists. Qualified Providers of Conscious Sedation Position

Statement 2.2. Park Ridge, IL: American Association of Nurse Anesthetists; 1996.

 

Caperelli-White, L., & Urman, R. D. (2014). Developing a Moderate Sedation Policy: Essential Elements and Evidence-Based Considerations. AORN Journal, 99(3), 416-430. doi:10.1016/j.aorn.2013.09.015

 

Conway, A., Rolley, J., Page, K., & Fulbrook, P. (2014). Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study. Journal Of Advanced Nursing, 70(5), 1040-1053. doi:10.1111/jan.12337

 

Conway, A., Rolley, J., Page, K., & Fulbrook, P. (2014). Issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a qualitative study. Journal Of Clinical Nursing, 23(3/4), 374-384. doi:10.1111/jocn.12147

 

Ketcham, E., Ketcham, C., & Bushnell, F. L. (2013). Patient safety and nurses' role in procedural sedation. Emergency Nurse,21(6), 20-24. doi:10.7748/en2013.10.21.6.20.e1218

 

Murphy, J. M. (2013). Credentialing Process for Nurse Providers of Moderate Sedation. Journal Of Radiology Nursing, 32(1), 10-18. doi:10.1016/j.jradnu.2012.06.002

 

Ogg, M. (2008). Clinical issues. Recommended practices for moderate sedation/analgesia. AORN Journal, 88(2), 275-277.

 

Registered Nurses Engaged in the Administration of Sedation and Analgesia. (2005, November 1). Retrieved May 7, 2015, from http://www.aana.com/resources2/professionalpractice/Documents/PPM Consid 4.2 RNs Engaged in Sedation Analgesia.pdf

 

Spruce, L. (2015). Back to Basics: Procedural Sedation. AORN Journal, 101(3), 345-353. doi:10.1016/j.aorn.2014.09.011

 

Wunder L, Glymph D, Newman J, Gonzalez V, Gonzalez J, Groom J. Objective Structured Clinical Examination as an Educational Initiative for Summative Simulation Competency Evaluation of First-Year Student Registered Nurse Anesthetists’ Clinical Skills. AANA Journal [serial online]. December 2014;82(6):419-425. Available from: CINAHL with Full Text, Ipswich, MA. Accessed April 5, 2015.