1997 OPEN FORUM Abstracts
ADMINISTRATION OF IV CONSCIOUS SEDATION BY RESPIRATORY CARE PRACTITIONERS: THE EFFECT ON PHYSICIAN PRACTICE.
David Wheeler RRT, Ken Hargett RRT, Cathy Meents RRT, Rusty Reld RRT, The Methodist Hospital, Houston, Texas
Introduction: Conscious Sedation is utilized to decrease anxiety, provide analgesia, produce amnesia or any combination of these for the purposes of diagnostic, therapeutic, or surgical procedures. Conscious sedation is administered in many areas of the hospital and has been highlighted by JCAHO to determine if adequate policies and procedures exist to insure patient safety. Our hospital assigned a multi disciplinary task force to develop and implement an institution wide Conscious Sedation policy. The Respiratory Care Department provides the bronchoscopy services for the entire hospital and was included on the task force. A formal hospital level policy approved by Anesthesia, Pharmacy and Therapeutics, and Medical Staff Executive Committee was developed. The policy designated that only competency verified RN's and Registered Respiratory Therapists could administer conscious sedation utilizing a strict protocol. Methods: A self-study program was developed and Registered Therapists within the department were competency verified to administer and monitor conscious sedation during bronchoscopy. A post test was administered and a skills checkoff was included in the competency verification. Experience: Prior to the development of the Conscious Sedation policy, administration of conscious sedation drugs was uncontrolled and unmonitored. Over-sedation results in increased patient risk and necessitates reversal agents which result in additional cost to the hospital/patient in regards to drugs and monitoring time. The cost of Mazicon to the department is $30.00/dose. As part of the Respiratory Care Quality Improvement process, the administration of conscious sedation was monitored specifically looking at reversal of conscious sedation as an indicator of overdose. A retrospective review of bronchoscopy records showed that in the nine months prior to the implementation of the policy, 20% (121/609) of patients undergoing bronchoscopy had to be reversed. After the implementation of the policy and rigid adherence to the uniform protocol by the Respiratory Therapist a decline in reversal rates was noted. Initially, the reversal rate fell to 8%(19/232) over the first three months. As more Respiratory Therapist were trained, the reversal rate fell to 4% over the next nine months (39/935). This decrease in reversals resulted in a cost savings of $4400 during this period. Conclusions: Within our institution, we have demonstrated that Registered Respiratory Therapists, following a carefully designed Conscious Sedation Protocol, can effectively administer IV conscious sedation. Our reversal rate for excessive sedation during bronchoscopy has decreased from 20% to 4%. We conclude that meticulous monitoring of conscious sedation administration by a Registered Respiratory Therapist has favorably altered physician practice as evidenced by the significant reduction in patients requiring analgesic reversal. This change in physician practice has resulted in a cost savings to the Respiratory Care Department.