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J Accid Emerg Med. 1999 March; 16(2): 120–122.
PMCID: PMC1343296

A risk management audit: are we complying with the national guidelines for sedation by non-anaesthetists?


OBJECTIVES: To assess the effect of a preprinted form in ensuring an improved and sustained quality of documentation of clinical data in compliance with the national guidelines for sedation by non-anaesthetists. DESIGN: The process of retrospective case note audit was used to identify areas of poor performance, reiterate national guidelines, introduce a post-sedation advice sheet, and demonstrate improvement. SETTING: Emergency Department, Musgrove Park Hospital, Taunton. SUBJECTS: Forty seven patients requiring sedation for relocation of a dislocated shoulder or manipulation of a Colles' fracture between July and October 1996 and July and October 1997. MAIN OUTCOME MEASURES: Evidence that the following items had been documented: consent for procedure, risk assessment, monitored observations, prophylactic use of supplementary oxygen, and discharging patients with printed advice. Case note review was performed before (n = 23) and after (n = 24) the introduction of a sedation audit form. Notes were analysed for the above outcome measures. The monitored observations analysed included: pulse oximetry, respiratory rate, pulse rate, blood pressure, electrocardiography, and conscious level. RESULTS: Use of the form significantly improved documentation of most parameters measured. CONCLUSIONS: Introduction of the form, together with staff education, resulted in enhanced documentation of data and improved conformity with national guidelines. A risk management approach to preempting critical incidents following sedation, can be adopted in this area of emergency medicine.

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Selected References

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  • Kendall JM, Allen PE, McCabe SE. A tide of change in the management of an old fracture? J Accid Emerg Med. 1995 Sep;12(3):187–188. [PMC free article] [PubMed]
  • Ilkhanipour K, Juels CR, Langdorf MI. Pediatric pain control and conscious sedation: a survey of emergency medicine residencies. Acad Emerg Med. 1994 Jul-Aug;1(4):368–372. [PubMed]
  • Hewitt S, Hartley R. Intravenous sedation in accident and emergency departments: a nationwide survey. Ann R Coll Surg Engl. 1994 May;76(3):213–213. [PMC free article] [PubMed]
  • Aslam BH, Woods I. Intravenous sedation in accident and emergency departments: a nationwide survey. Ann R Coll Surg Engl. 1994 Jan;76(1):19–21. [PMC free article] [PubMed]
  • Inglis A, Daniel M. A survey of information supplied to day-case patients. Health Bull (Edinb) 1995 Mar;53(2):91–93. [PubMed]
  • Santos LJ, Varon J, Pic-Aluas L, Combs AH. Practical uses of end-tidal carbon dioxide monitoring in the emergency department. J Emerg Med. 1994 Sep-Oct;12(5):633–644. [PubMed]
  • Robinson SM, Harrison BD, Lambert MA. Effect of a preprinted form on the management of acute asthma in an accident and emergency department. J Accid Emerg Med. 1996 Mar;13(2):93–97. [PMC free article] [PubMed]
  • Quine MA, Bell GD, McCloy RF, Charlton JE, Devlin HB, Hopkins A. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods. Gut. 1995 Mar;36(3):462–467. [PMC free article] [PubMed]
  • Jackson R, Feder G. Guidelines for clinical guidelines. BMJ. 1998 Aug 15;317(7156):427–428. [PMC free article] [PubMed]

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