From the 2024 HVPA National Conference
Rabie Kilan, Master (JHAH)
Team
Dr. Fahd Algurashi; Project Owner, Malgorzata Rzepniewska; Physician Lead, Dr. Fuad Maufa; Nurse Lead, Ashraf Jaradat; Project Facilitator, Abdalazeez Abugharibh; Unit Senior Director, Eyad Haj Hussein
Dr. Fawaz Habib, Mohammad Rizk, Elham Quraish, May AlMuqarrab, Joy Anes and Rami Itani
Background
The safe administration of invasive procedures such as sedation for endoscopic procedures requires patient assessment prior to sedation to decrease the risk of complications. The assessment should be completed by the endoscopist/sedation provider and be properly documented in the patient’s Epic medical record before sedatives are administered.
A critical element of the assessment is airway assessment. If this isn’t done, complications could occur during recovery, which prior to this project was not documented in OPPA for conscious sedation procedures.
Aim
Achieve a ≥ 90% compliance rate by end of 2021 for pre-procedure airway assessment to ensure the safety of patients, reduce the risk of airway complications, and meet accreditation requirements.
Method
A multidisciplinary team was formed that comprised physicians, nurses, and Epic experts. The team conducted a literature review on best practices and developed a protocol and implemented a force function in Epic, the electronic patient record system at JHAH, to be followed pre-procedure for all endoscopy patients. The project was successfully piloted in OPPA and then rolled out across JHAH.
Interventions
- Gained consensus among practitioners in OPPA and involved anesthesia SMEs.
- Developed a hard stop function in Epic to ensure airway assessment is done before sedation.
- Educated OPPA and Endoscopy staff on the new process and provided it to everyone involved in sedation.
- Developed a JHAH Pre-Procedure Airway Assessment Compliance report in Epic.
- Produced monthly monitoring reports that include the percentage of documented pre-procedure patient assessments by each endoscopist or other sedation provider, as well as any complications or sedation-related adverse events.
Result
Achieved compliance rate post-implementation of 99%-100% due to provided buy-in, system fix, and force function implementation.
Conclusion
Sedation for gastrointestinal endoscopy procedures, as well as any other invasive procedures, can be safely and effectively performed with a multi-drug IV regimen utilizing an anesthesiologist or non-anesthetic personnel with appropriate monitoring; however, comprehensive pre-sedation assessment, proper patient selection and preparation, and the availability of skilled professionals for sedation administration are key components for patient safety and care. Additionally, the physician must always be prepared to revive patients who move to a deeper level of sedation, and there should be an awareness of possible complications.
References
- JCIA 7th edition
- Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018, Anesthesiology March 2018, Vol. 128, 437–479.