2003 OPEN FORUM Abstracts
Broaden the Respiratory Scope of Practice: Pediatric Sedation Monitoring
Gail Roberts RRT-NPS, AE-C, Children's Medical Center of Dallas
Introduction One of the major concerns of pediatric patients, families
and healthcare providers is the endurance of pain or use of forcible restraint
during procedures. In
the past decade, the knowledge of the safety and efficacy of sedation medications
used in pediatric patients has advanced dramatically. With this knowledge,
pediatric healthcare providers can effectively sedate their patients with minimal
negative psychological responses or discomfort. Sedation is a continuum;
therefore, a standard level of care and monitoring needs to be established in
order to assure patient safety and welfare. The foremost concern with the
use of sedation medications is the patient's inadvertent potential to lose and
or to maintain spontaneous ventilatory function. The respiratory care practitioner
(RCP) is the most qualified clinician in the healthcare field to assess respiratory
status and is essential to the guarantee of pediatric patient safety with the
implementation of advanced therapeutics that involve potential compromise of
the cardiopulmonary system.
Methods A focus group comprised of the Chief of Anesthesiology, respiratory
care practitioners, nurses and educators, utilized the Plan-Do-Check-Act methodology
of process improvement
in order to develop a standard of care and monitoring guidelines for pediatric
patients receiving sedation during diagnostic or therapeutic procedures. The
goals of the group were to develop a uniform training and credentialing program
for non-anesthesia personal. Eligibility requirements of sedation credentialing
included: licensed RCP, RN or LVN with possession of the Pediatric Advanced Life
Support (PALS) and Basic Life Support (BLS) credentials, successful completion
of the Children's Medical Center of Dallas sedation module; based on the American
Society of Anesthesiologist guidelines for conscious sedation, and post-test,
achievement of Clinical Competency of Airway Management and Airway Competency
Assessment Tools.
Results Maintenance of Children's Medical Center of Dallas' improved standard
of care required additional staff. Two licensed and sedation credentialed healthcare
providers at the patient's bedside during all procedures requiring sedation was
mandated. Respiratory Care Services was able to support this much needed
standard of care, by supplying seven full time employees (plus a pool of resource
practitioners) to the in-patient and out-patient areas who sedate many pediatric
patients daily for procedures.
Conclusion The goal of pain-free procedures was met by RCPs, the only
professionals
qualified
and available to assure the safety and welfare of our smallest patients. As
nursing shortages continue to have an affect on patient care, RCPs are certainly
one of the best healthcare providers to help fill the voids with their keen patient
assessment and crucial critical thinking skills.