The Science Journal of the American Association for Respiratory Care

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. 

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