Implementation of a Pre-Procedural Sedation and Analgesia Safety Checklist
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The purpose of this quality improvement project was to implement a standardized pre-procedural sedation checklist in the emergency department (ED). The intent was to discern whether the checklist would lessen the morbidity and mortality rates associated with procedural sedation and analgesia (PSA), and increase the application of safety measures. The setting was a 24-bed adult ED. The project amassed a sample of 49 adult patients who underwent PSA in the ED. Exclusion criteria entailed patients sedated for drug assisted intubation. This initiative introduced the Emergency Department Pre-Procedural Sedation Safety Checklist which was to be completed prior to induction. Instructions for application were provided to staff nurses via video presentation. 49 patients met inclusion criteria, of which the intervention was utilized in six of 49 procedures (12.2%). Of the six comprising the intervention group, there were zero unplanned interruptions, hospital admissions, or moralities. Of the 43 which did not observe the checklist, there were three unplanned interruptions, two unplanned hospital admissions, and one death. Nurses charted verification of procedure consents in 23/43 and presence of staff, equipment, and assessments in 29/43 procedures which did not observe the checklist. The intervention group exhibited 6/6 sedations which observed the desired safety metrics and verified procedure consents. The intervention group exhibited superior rates of observance to safety measures, consent verification, and decreased morbidity and mortality as compared to procedures which did not utilize the checklist. However, it is inappropriate to compare the two populations due to disparate sample sizes. Checklists may lessen adverse events related to PSA; further investigation is warranted.
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