Priority populations

Local and NSW Health policies and procedures inform sedation care. There are specific considerations for some patient cohorts.

NSW Health aims to provide quality health services that are accessible, non-discriminatory and equitable. Patient groups requiring supports and adjustments:

• Aboriginal patients
• Culturally and linguistically diverse patients
• Patients with intellectual disability
• Rural and regional patients

Aboriginal patients

Healthcare services should be culturally relevant and safe. They should empower and actively involve Aboriginal families and carers in decision making. Sedation providers and their teams should:

• use shared decision making resources for Aboriginal people and their healthcare professionals to make decisions together, such as the ‘Finding your way’ shared decision making model
• coordinate with local health services or a patient’s usual doctor or healthcare worker to provide preoperative services close to home and on Country for rural and remote locations
• engage Aboriginal health workers or Aboriginal liaison officers, where available, to foster understanding and trust and help coordinate care; for example, attendance at pre-admission clinics and travelling to hospital.

Deliver culturally safe care for Aboriginal patients. Take the time to yarn about treatment options, including the benefits, risks and longer-term implications of treatment decisions. Ensure the patient and their family or support network are meaningfully involved in a shared decision-making process. Conversations should be guided by cultural protocols and communication preferences, using plain language and culturally appropriate resources.

Providing patient-centred care requires a respectful understanding of cultural values, beliefs and communication preferences. Where possible, coordinate care for Aboriginal patients so they can receive investigations, assessments and treatments closer to, or on, Country; and engage local Aboriginal health and social work teams.

Some Aboriginal patients use alternative medicines as part of their healing practices. Maintain flexibility and sensitivity to Aboriginal healing practices through open communication with the entire health team.

Culturally and linguistically diverse patients

NSW Health supports culturally responsive care that recognises and respects linguistic and cultural needs. This commitment includes providing access to care and supporting health literacy to enable shared decision making.

When supporting culturally appropriate care for a patient from a culturally and linguistically diverse background, the sedation provider and their team should:

• access an interpreter if the patient does not speak English as a first language. This service can be by telephone or videoconferencing
• provide accessible translated written communication.

Patients with intellectual disability

Procedural sedation for individuals with intellectual disabilities requires special considerations to ensure safety, comfort and effective management of both the procedure and any behavioural or medical complexities.

The Intellectual Disability Network has a collection of resources that support the delivery of healthcare for people with intellectual disability.

Pre-sedation assessment

A comprehensive telehealth consultation is necessary and often the only option for patients with intellectual disability. This presents a challenge in undertaking a physical assessment, and often means relying on paperwork, history and any further information provided by the carer. Review any previous sedation and anaesthetic history to identify past complications or effective strategies.

Consent and next of kin or guardian involvement

The next of kin or guardian will often need to provide consent on behalf of patients with intellectual disability, therefore they need to be present to consent to any changes to pre-discussed and agreed arrangements.

Involving familiar caregivers is also important for comfort and reassurance. They can provide critical information regarding baseline behaviour, triggers for distress and effective calming strategies.

Environment

Make reasonable adjustments to ensure a quiet, calm and sensory-friendly setting. Where possible, wait times should be minimised to reduce anxiety. Distraction techniques such as music, videos and comfort items should also be considered.

Recovery

Patients with intellectual disability may need to be kept in recovery for longer than other patients. They may become agitated by unfamiliar environments and people. Make adjustments to allow the carer to stay with the patient where possible.

Other considerations

• A behavioural support plan.
• The patient’s preferred communication devices, such as an electronic device or communication boards.

Rural and regional patients

Consider the unique needs of rural and regional patients.

The Rural Health Network works to improve information access and early identification of rural patients, their families and carers.

Before performing a procedure, the risk of the procedure should be considered to ensure that multidisciplinary care and appropriate support can be provided to the patient in the event of a complication or deterioration.

A patient living in a regional or remote area may need help with transport, accommodation and engaging local resources.