Strong professional relationships and high-quality training support safe procedural sedation.
Skilled support
Units and departments with well-functioning procedural sedation services usually have collaborative relationships with their local anaesthesia department (where one exists).
A nominated procedural sedation contact within the anaesthesia department (or other department with specialised skills) can assist with developing and updating the triage and risk assessment processes, and locally agreed referral criteria.
If this contact person is not the head of the anaesthesia department, the explicit support of the department head should be sought.
Training
In settings where non-anaesthetist sedation is regularly administered, units and departments should access high-quality training to ensure safe and effective monitoring and management of sedated patients.
Training should include skills in the following areas:
- Knowledge
- Processes that should occur along the patient journey
- Equipment used in normal sedation and for airway emergencies
- Pharmacology of drugs used
- Skills: airway skills and use of airway adjuncts
- Affective: human factor skills and attitudes
In many hospitals, this training is provided by anaesthesia departments via simulation-based training or regular rotation of staff to operating theatres or recovery units.
If anaesthetic departments are unable to provide training, it may be provided by other critical care teams, e.g. from the emergency department or intensive care unit.
High-quality training is:
- delivered by appropriately trained and skilled clinicians to support the achievement of learning outcomes
- interactive and multidisciplinary
- of sufficient duration to enable participants ample time for hands-on practice with real-time coaching and feedback from facilitators to ensure good airway management technique
- inclusive of the learning outcomes outlined in ANZCA PG09(G) Appendix IV Safe procedural sedation competencies via a combination of reference materials (pre- or post-course reading), small-group learning sessions, skills training and, where feasible, mannequin-based immersive simulation
- delivered with an adequate number of instructors for the group size, e.g. group size of 8–12 requires at least 2–3 instructors
- assessed using participant feedback
- delivered by providers with quality assurance and quality improvement processes in place to drive quality and ensure the training is relevant and up to date.