Pre-procedural preparation

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Patients should be properly prepared before a procedure to ensure safe sedation.

Consent

Informed consent requires shared decision making between the healthcare team, the patient and their family or carers. It is the patient's decision to agree to the procedure, and the patient can give or withdraw consent at any time.

This acknowledgement can be verbal and documented in the clinical notes. However, if significant risks are identified, they should provide written consent.1

Consent must take place after the patient has:

  • received accurate and relevant information about the surgery or procedure, and other treatment options
  • adequate knowledge to consider the benefits and risks of the surgery or procedure
  • considered what to do if there are any complications
  • collaboratively discussed their goals and wishes.2

Considerations:

  • If a patient is unable to give consent, obtain consent from an appointed guardian or a person responsible.3
  • An interpreter is essential for a patient who does not speak or read English.
  • Consent must be documented.4
  • Patients should be informed that they may have some recollection of the procedure if undergoing mild or moderate sedation.

Resuscitation plan

Where a patient has a resuscitation plan, this must be reviewed with the patient, person responsible and proceduralist to determine whether it is appropriate to suspend it during the intra- or post-procedural period. This decision must be clearly documented in the medical record.

Reviewing or reinstating the resuscitation plan should be discussed with the patient at an appropriate time following the procedure.

Fasting

All patients must be appropriately fasted before their procedures to reduce harm from pulmonary aspiration.

This should be in accordance with current standards or local policy, which may include Sip Til Send protocols. This may need modification in specific circumstances, i.e. glucagon-like peptide-1 receptor agonists.

Fasting may not be required for some patients undergoing mild sedation.

Resources

PG09(G) Guideline on procedural sedation 2023
This guideline provides further guidance on preparation required for procedural sedation.
Source: Australian and New Zealand College of Anaesthetists

Medication

Give patients clear preoperative medication instructions. Carefully manage people using diabetic and anti-thrombotic medications.

Restraint

Restraint must only be used as a last resort after less restrictive alternatives have been trialled and considered, and only if the patient is in danger of hurting themselves or others.

Resources

Seclusion and Restraint in NSW Health Settings (PD2020_004)
This policy directive outlines efforts to eliminate the use of restraint in NSW Health settings.
Source: NSW Health

Consent to Medical and Healthcare Treatment Manual – Section 10.9 – Restrictive practices
This document outlines consent requirements for specific procedures, including anaesthesia.
Source: NSW Health

References

  1. NSW Ministry of Health. Consent to Medical and Healthcare Treatment Manual – Section 4 – Requirements for consent.NSW, Australia: NSW Ministry of Health; 30 Apr 2025 [cited 12 Aug 2025].
  2. Australian Commission on Safety and Quality in Health Care. Informed consent. Sydney: ACSQHC;  2024 [cited 12 Aug 2025].
  3. NSW Civil and Administrative Tribunal. Consent to medical or dental treatment. NSW, Australia: NCAT; 8 Sep 2022 [cited 12 Aug 2025].
  4. Vogel A, Guinemer C, Fürstenau D. Patients' and healthcare professionals' perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review. BMC Health Serv Res. Feb 24 2023;23(1):197. DOI: 10.1186/s12913-023-09120-4
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