#1 - Nurses and Sedation

I. Historical Considerations – How did we get to this point?

II. RN Practice Control and Scope of Practice

A. Board of Registered Nursing
B. Professional Organizations
C. Accrediting Bodies
D. Facility Policies and Procedures

III. Pushing the Envelope – Who? When? Why?

IV. Legal Concerns

A. Negligence Law
B. Consent law
C. Liability Prevention

V. The Impact of Health Care Reform – How will practice change?

A. Competence Statement Development and Implementation

Behavioral/Learning Objectives:

1. Describe the societal changes in health care delivery that have led to greater utilization of nonanesthesia providers to provide procedural sedation.
2. Outline the criteria set by many professional state registry boards for specific providers to perform sedation for procedures.
3. Explain the impact of accrediting agencies on the utilization of nurses to provide procedural sedation.
4. Identify at least two legal concerns for nonanesthetists providing procedural sedation.
5. Explain how to write a sample competence statement for nurses providing procedural sedation
6. Describe the potential effects of health care reform on the need for provision of procedural sedation by professionals other than anesthetists.
   

#2 - Presedation Assessment and Monitoring

I. Patient counseling and Informed consent

II. Physical Assessment

A. Health status evaluation
B. Indications for specific lab and diagnostic studies
C. Specific disease and medication concerns-Sleep apnea, pacemakers, asthma, drug abuse, herbal medications, etc
D. Fasting Status Criteria
E. ASA (PS) Classification

III. Essential Monitors

A. ECG, Blood Pressure, Level of Consciousness, End-tidal CO2 ,Pulse oximetry, Bispectral index analysis

IV. Prevention and Treatment of alterations in cardiac dynamics

A. Hypotension, hypertension, dysrhythmias

Behavioral/Learning Objectives:

1. Identify the required components of Informed Consent for Sedation.
2. List the components of appropriate health status assessment of adult patients prior to sedation.
3. Define specific types of patients in whom presedation laboratory and x-ray tests may be necessary
4. Outline advantages and disadvantages of monitors that are essential for use during procedural sedation.
5. Outline the basic concepts of consciouness assessment during sedation utilizing scales or monitors.
6. Describe common factors that produce hypotension or hypertension in patients during moderate sedation.
7. Describe decision-making rationales for treatment of intra-procedural hypo- or hypertension.
   

#3 - Sedating Pediatric Patients

I. Goals for sedation

II. Pediatric Assessment – Understanding differences in pediatric physiology

III Techniques and Monitoring Criteria

A. Temperature regulation, oxygenation, airway, fluid replacement
B. Sedation medications, administration teachniques

IV. Adverse Events and Outcomes – failed sedation

V. When to say “no”

Behavioral/Learning Objectives:

1. List the goals of sedation for children.
2. List the components of appropriate health status assessment of infants and children prior to sedation.
3. Identify the differences in cardiovascular and nervous system dynamics between children and adults
4. Explain which monitors are essential for use during procedural sedation of children/infants.
5. Outline the basic concepts of consciouness and pain assessment in children/infants utilizing scales or monitors.
6. Briefly discuss the advantages and potential disadvantages of four common drug combinations used to sedate children.
   

#4 - The Pharmacology of Drugs Used During Procedural Sedation

I. Pharmacological characteristics of:

A. Ketamine
B. Propofol (Diprivan), fospropofol(Lusedra)
C. Barbiturates and chloral hydrate
D. Narcotics- Fentanyl and Friends
E. Sedatives – Midazolam and Friends

II. The Use of Local Anesthetics

III. Adjuvant Drugs

A. Glycopyrrolate/Atropine
B. Naloxone
C. Flumazenil
D. Ondansetron and friends
E. Cardiovascular stimulants

Behavioral/Learning Objectives:

1. Describe the mechanisms of action of common drugs used for procedural sedation.
2. Explain the potential use of automated drug administration systems.
3. Outline appropriate parameters within which nurses may administer and monitor the administration of propofol or similar agents.
4. Identify the major physiological effects expected following the intravenous administration of narcotics and/or sedatives.
5. Describe the symptoms associated with local anesthetic toxicity and outline the treatment necessary.
6. Identify appropriate situations in which the use of reversal agents may be necessary.
   

#5 - Techniques for Achieving Moderate Sedation

I. Presedation decisions
II. Type and duration of procedure, expected need for pain relief and/or anxiolysis
III. Titration of medications to desired effect
IV. Bolus versus continuous infusion techniques
V. Advantage and disadvantages of each technique of administration
VI. Anticipating Difficult Patients

Behavioral/Learning Objectives:

1. Explain the sequence in which medications should be titrated to produce desired levels of sedation and/or analgesia.
2. Define the essential timing concepts of appropriate titration techniques in sedation administration.
3. Describe factors that contribute to the choice of one administration technique over another for the establishment of moderate sedation.
4. List basic considerations of administration of sedatives to the geriatric patient.

#6 - Managing Complications and Controversies

I. Respiratory Complications – airway management, oxygen administration, resuscitation
II. Cardiovascular Complications
III. Drug Interactions of clinical concern
IV. Controversies – Where Should the Line be Drawn?
V. Case Studies
VI. Final Thought

Behavioral/Learning Objectives:

1. Describe physiological and positional factors that can complicate management of the airway during sedation.
2. Explain the causes and management of bradycardia or PVC’s during procedural sedation.
3. List three drug interactions that may be of concern during procedural sedation.
4. Identify one major issue that may be of concern as the role of non-anesthesia professionals in provision of procedural sedation expands.
   

Accreditation Information

Nurses – Academy Medical Systems is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Academy medical Systems is also a provider approved by the California Board of Registered Nursing, provider #CEP14413, for 9.0 hours. And we are also a provider approved by the Florida Board of Nursing, provider #50-19, for 9.0 hours.

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.

Certified Nurses - Most certifying organizations recognizeAMS’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).

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