The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

DEVELOPMENT OF A PRE-PROCEDURAL SEDATION AIRWAY ASSESSMENT TOOL TO DETERMINE POTENTIAL NEED FOR INTERVENTION DURING PROCEDURAL SEDATION

J. Fielder1, T. Smith1, R. Gilbert1, S. Gaines2

Background: The increased usage of procedural sedation (PS) without an Anesthesiologist, presented our department with increased requests and demands for airway assessments. We found it necessary to develop a tool that would allow us to effectively make consistent decisions regarding the presence of a Respiratory Care Practitioner (RCP) at these procedures. We developed an Assessment Tool to meet the following objectives: Allow RCP’s to make consistent decisions regarding the need for intervention during PS. Allow Anesthesia to be contacted for further evaluation. Develop a post-procedure review to determine if assessment matched actual outcome.

Method:
A Pre-Procedural Assessment tool was designed to assess three airway risk situations. First, the risk of obstructive sleep apnea (OSA), whether diagnosed or undiagnosed is assessed. Undiagnosed OSA is evaluated via the Epworth Sleepiness Scale. Second, the risk of pulmonary complications and potential of difficult bag/mask ventilation is assessed. Third, a difficult airway is defined by use of 4 criteria; a Mallampati score, thyroid cartilage to chin length, incisor gap, and history of head neck surgery. These three airway risk situations result in the patient being scored a 1, 2 or 3. The scores result in the following recommendations: 1. Patient is cleared to have PS, an RCP will be on standby. 2. RCP will be present at procedure. RCP to be present at onset of sedation. 3. Patient’s medical condition suggests Anesthesia be contacted for evaluation. A post procedure review sheet was developed to allow data to be gathered as to the airway interventions that actually occurred.

Results:
A review of collected data shows the following. Patients who scored a 1 was 81%, scored a 2 was 11%, and scored a 3 was 8%. Patients that scored a 1, 83% did not require intervention, 17% required minimal intervention by the RN, and the RCP was never called to intervene. Patients that scored a 2, 50% did not require intervention and 50% required intervention. Patients that scored a 3, 100% were managed by Anesthesia.

Conclusion: The Pre-Procedural Sedation Assessment tool has been effective in allowing RCP’s to safely screen patients pre-procedure. We feel our statistics show we can safely rely on our assessment tool to help us determine the need for RCP presence when patients have PS.

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