These standards outline the key components of safe procedural sedation to support NSW public health services to provide high-quality patient care.
While many of the principles in this guide represent good procedural sedation practice, the standards are not intended to be used in certain specialised settings such as the pre-hospital environment, intensive care units (ICU), close observation units, birthing suites, paediatrics or for the management of patients with severe behavioural disturbance requiring restraint.
The standards are applicable to all modes of sedation – oral, inhalational, intravenous, intramuscular and intranasal – and are intended to be used in conjunction with local protocols.
These standards have been developed for NSW public hospitals, but the general principles, reflecting best practice, are applicable to all clinical settings. As such, they may provide a useful guide for other facilities in NSW, including private settings.
The standards comply with the NSW Health Clinical Procedure Safety Policy (PD2025_006) and are aligned with the Australian and New Zealand College of Anaesthetists Guideline on procedural sedation 2023. These standards should be referred to for mild or moderate sedation, however, the practice of deep sedation falls outside its scope.
Recommendations for the training and accreditation required to be a sedation provider are outside the scope of these standards, as is any course content and the certification of such courses or facility credentialing.
Patients requiring emergency (or unplanned) procedures (outside of the operating theatre, ICU and emergency department) require an assessment to determine whether an anaesthetist or critical care physician (CCP) is required.
Patients with conditions posing an immediate threat to life or limb must have a CCP present, or immediately available.
Patients who are fasted, stable and otherwise well but appear on the “emergency” list can receive standard care.
Acknowledgements
Thank you to the following individuals who were involved in the development of this resource.
- Christian Abel, Radiologist, Hunter New England LHD
- Rummana Afreen, Staff Specialist, Western Sydney LHD
- Deidre Brogan, Clinical Nurse Consultant, Sydney Children's Hospitals Network
- Alexandra Buchanan, Visiting Medical Officer Anaesthetist, Sydney LHD
- Megan Budek, Clinical Nurse Consultant, Nepean Blue Mountains LHD
- Nick Burgess, Clinical Director Gastrointestinal Endoscopy and Senior Staff Specialist Gastroenterologist, Western Sydney LHD
- Deborah Burrows, District Clinical Nurse Consultant Perioperative Services, Southern NSW LHD
- Mavis Chan, Clinical Nurse Educator Endoscopy, Western Sydney LHD
- Megan Courtney, District Clinical Nurse Consultant Perioperative Services, South Western Sydney LHD
- Melinda El-Melki, Clinical Nurse Educator, Northern Sydney LHD
- Scott Fortey, District Director Anaesthesia and Specialist Anaesthetist, Central Coast LHD
- Richard Halliwell, Anaesthetist, Western Sydney LHD
- Kenneth Harrison, Senior Staff Specialist Anaesthetics, Western Sydney LHD
- Giselle Hollinshead, Consumer contributor
- Shangeetha Kumaresan, Emergency Medicine Specialist, South Western Sydney LHD and Sydney Children’s Hospitals Network
- Louise Mackie, Clinical Nurse Educator, Nepean Blue Mountains LHD
- Candice Maher, Acting Perioperative CNC / CNE Operating Theatres, Western NSW LHD
- Ann Marie McCallum, Specialist Anaesthetist, Western Sydney LHD
- Cate McIntosh, Conjoint Associate Professor, Director Hunter New England Simulation Centre
- Brianna Mitchell, Clinical Nurse Specialist Radiology, Sydney LHD
- Benjamin Piper, Specialist Anaesthetist, Hunter New England LHD
- Lucy Ramon, Senior Staff Specialist Rehabilitation Physician, South Eastern Sydney LHD
- Sophie Rayner, Cardiology Clinical Nurse Consultant, Sydney LHD
- Brad Sheridan, Staff Specialist Anaesthetist, Hunter New England LHD
- Ashlee Shoard, Nurse Educator Medical Imaging Services, Illawarra Shoalhaven LHD
- Arpit Srivastava, Anaesthetist, Northern Sydney LHD
- Stuart Thomas, Cardiologist, Western Sydney LHD
- Bradley Wilsmore, Staff Specialist Cardiologist, Hunter New England LHD