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Nurses Providing Sedation in the ASC Key elements for setting up a successful program BY JENNIFER BUTTERFIELD, CASC


RNs in the ASC setting are being asked to provide moderate or “conscious” sedation when anesthe- sia practitioners, such as


anesthesiologists (MDA), certified registered nurse anesthetists (CRNA) or anesthesiologist assistants (AA), are not available. Lack of availability might be due to a regional shortage, a patient request to avoid the expense, the refusal of an insurance provider to cover anesthesia services or other rea- sons specific to an ASC’s practices. An ASC’s need for RNs trained


and experienced in critical care, emer- gency and/or peri-anesthesia spe- cialty areas has risen, as it is these individuals that might be given the


responsibility, under the direction of a physician, to administrator conscious sedation medications. During my session, “Nurses Pro- viding Sedation in the ASC (Training/


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Competency)” at ASCA 2016, May 19–22 in Dallas, Texas, I will address five key elements for a successful con- scious sedation program in the ASC setting: 1) establishing facility guide- lines, 2) ensuring proper RN training and competency, 3) having appropriate RN and physician credentialing, 4) hav- ing proper documentation for the medi- cal record and 5) meeting the guidelines as set by The Joint Commission, the Accreditation Association for Ambulatory Health Care (AAAHC), the American Society of Anesthesiologists (ASA) and other regulatory agencies. In my discussion of facility guide- lines, I will identify specific policies that help to establish the purpose of conscious sedation, including uniform requirements and minimum standards for the use of conscious sedation for therapeutic, diagnostic or surgical pro- cedures performed in the ASC setting. I will also review the definition of the different levels of sedation that can be achieved either intentionally or unin- tentionally as these will become the framework of your policies. Your facility’s guidelines need to be comprehensive in order to pilot practi- tioners through the experience of con- scious sedation as there are many ques- tions and concerns raised by nursing organizations and health care institutions with respect to these practices and the necessary qualifications of practitioners involved in this care. A facility should never allow a post-anesthesia care unit (PACU) RN, for example, to be pulled to endoscopy to provide conscious sedation because a gastrointestinal (GI) physician found out at the last minute that his/her patient did not want to pay for anesthe- sia. Much more thoughtful work needs to go into a conscious sedation program before a facility is able to safely care for a patient that receives non-anesthesiolo- gist/CRNA provided sedation. For RN training and competency, I will discuss the responsibilities of the RN in achieving safe patient selec-


ASC FOCUS MAY 2016


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