Current Issues and Future Possibilities ()
The safe provision of sedation requires knowledge of pertinent physiology, pharmacology, monitoring , and administration techniques. In today's increasingly complex health care delivery system , the need for professionals who are skilled in sedation techniques in both inpatient and outpatient settings continues to expand. In this on demand presentation concepts that ensure patient safety by increasing critical decision-making skills, as well as current practice controversies, new agents, and techniques will be explored.
Who Should Attend:
RNs working in OR, Ambulatory Surgery, ICU, CCU, Emergency Room, Gasteroenterology, Radiology, Pediatrics, Cardiac Labs, Acute Care Nurse Practitioners, Clinical Nurse Specialists, Acute Care Physician’s Assistants.
Linda Callahan, CRNA, PhD
Course Outline and Objectives:
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- I. Historical Considerations - How did we get to this point?
- RN Practice Control and Scope of Practice
- Board of Registered Nursing
- Professional Organizations
- Accrediting Bodies
- Facility Policies and Procedures
- Pushing the Envelope – Who? When? Why?
- Legal Concerns
- Negligence Law
- Consent law
- Liability Prevention
- The Impact of Health Care Reform – How will practice change?
- Competence Statement Development and Implementation
- Describe the societal changes in health care delivery that have led to greater utilization of nonanesthesia providers to provide procedural sedation.
- Outline the criteria set by many professional state registry boards for specific providers to perform sedation for procedures.
- Explain the impact of accrediting agencies on the utilization of nurses to provide procedural sedation.
- Identify at least two legal concerns for nonanesthetists providing procedural sedation.
- Explain how to write a sample competence statement for nurses providing procedural sedation
- Describe the potential effects of health care reform on the need for provision of procedural sedation by professionals other than anesthetists.
- Patient counseling and Informed consent
- Physical Assessment
- Health status evaluation
- Indications for specific lab and diagnostic studies
- Specific disease and medication concerns-Sleep apnea, pacemakers, asthma, drug abuse, herbal medications, etc
- Fasting Status Criteria
- ASA (PS) Classification
- Essential Monitors
- ECG, Blood Pressure, Level of Consciousness, End-tidal CO2 ,Pulse oximetry, Bispectral index analysis
- Prevention and Treatment of alterations in cardiac dynamics
- Hypotension, hypertension, dysrhythmias
- Identify the required components of Informed Consent for Sedation.
- List the components of appropriate health status assessment of adult patients prior to sedation.
- Define specific types of patients in whom presedation laboratory and x-ray tests may be necessary
- Outline advantages and disadvantages of monitors that are essential for use during procedural sedation.
- Outline the basic concepts of consciouness assessment during sedation utilizing scales or monitors.
- Describe common factors that produce hypotension or hypertension in patients during moderate sedation.
- Describe decision-making rationales for treatment of intra-procedural hypo- or hypertension.
- Goals for sedation
- Pediatric Assessment – Understanding differences in pediatric physiology
- Techniques and Monitoring Criteria
- Temperature regulation, oxygenation, airway, fluid replacement
- Sedation medications, administration teachniques
- Adverse Events and Outcomes – failed sedation
- When to say "no"
- List the goals of sedation for children.
- List the components of appropriate health status assessment of infants and children prior to sedation.
- Identify the differences in cardiovascular and nervous system dynamics between children and adults
- Explain which monitors are essential for use during procedural sedation of children/infants.
- Outline the basic concepts of consciouness and pain assessment in children/infants utilizing scales or monitors.
- Briefly discuss the advantages and potential disadvantages of four common drug combinations used to sedate children.
- Pharmacological characteristics of:
- Propofol (Diprivan), fospropofol(Lusedra)
- Barbiturates and chloral hydrate
- Narcotics- Fentanyl and Friends
- Sedatives - Midazolam and Friends
- The Use of Local Anesthetics
- Adjuvant Drugs
- Ondansetron and friends
- Cardiovascular stimulants
- Describe the mechanisms of action of common drugs used for procedural sedation.
- Explain the potential use of automated drug administration systems.
- Outline appropriate parameters within which nurses may administer and monitor the administration of propofol or similar agents.
- Identify the major physiological effects expected following the intravenous administration of narcotics and/or sedatives.
- Describe the symptoms associated with local anesthetic toxicity and outline the treatment necessary.
- Identify appropriate situations in which the use of reversal agents may be necessary.
- Presedation decisions
- Type and duration of procedure, expected need for pain relief and/or anxiolysis
- Titration of medications to desired effect
- Bolus versus continuous infusion techniques
- Advantage and disadvantages of each technique of administration
- Anticipating Difficult Patients
- Explain the sequence in which medications should be titrated to produce desired levels of sedation and/or analgesia.
- Define the essential timing concepts of appropriate titration techniques in sedation administration.
- Describe factors that contribute to the choice of one administration technique over another for the establishment of moderate sedation.
- List basic considerations of administration of sedatives to the geriatric patient.
- Respiratory Complications - airway management, oxygen administration, resuscitation
- Cardiovascular Complications
- Drug Interactions of clinical concern
- Controversies - Where Should the Line be Drawn?
- Case Studies
- Final Thought
- Describe physiological and positional factors that can complicate management of the airway during sedation.
- Explain the causes and management of bradycardia or PVC’s during procedural sedation.
- List three drug interactions that may be of concern during procedural sedation.
- Identify one major issue that may be of concern as the role of non-anesthesia professionals in provision of procedural sedation expands.
Nurses – Academy Medical Systems is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Academy Medical Systems (AMS) is also a provider approved by the California Board of Registered Nursing, provider #CEP14413.
AMS is also a provider approved by the Florida Board of Nursing, provider #50-19.
Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.
All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.
9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.
Certified Nurses - Most certifying organizations recognize AMS’s approved provider status with the ANCC and will honor our continuing education courses for nurses recertification requirements (with the exception of ACLS and PALS certification).
Requirements for successful completion: Each presentation must be viewed in its entirety. Following each presentation the completion of the post-test (with 70% accuracy) and evaluation is required to receive 1.5 contact hours per presentation or 9.0 contact hours for the entire series.
Contact Hours will be awarded for this course through 2/28/2016
Products produced and/or distributed by Commercial Interest Organizations (CIOs) mentioned during this presentation are for educational purposes only and should not be considered an endorsement by Academy Medical Systems, the course presenter, or the ANCC
No member of the planning committee has a relationship with a CIO that could create a conflict of interest in planning or presenting this material. Thank you.
Online Post-test and Evaluations for In-Service courses expires 90 days from the online registration date.