The following praiseed practices w...

The following praiseed practices were developed by the AORN make acceptableed Practices Committee and have been approved by the agency of the AORN Board of Directors. They were not awayed as proposed recommended practices for explanations by members and others. They are effective Jan 1 2002

These praiseed practices are intended as achievable recommendations representing what is believed to be an optimal flat of practice. Policies and practices will reflect variations in practice settings and/or clinical situations that determine the order to which the recommended practices can be implemented.

AORN recognizes the numerous patterns of settings in which perioperative feed at the breasts practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive proceedings may be performed.

Purpose: The use of moderate sedation/analgesia allows patients to tolerate unpleasant manner of proceedings while maintaining adequate cardiorespiratory function, protective reflexe and the ability to answer purposefully to verbal and/or tactile stimulation. (1)

Moderate sedation/analgesia is a specific flush or depth of sedation in the continuum of sedation (Table 1) It is not always possible to gauge for what cause a patient may respond to sedation; therefore, the health care professional intending to bring forward moderate sedation/analgesia should be able to extricate patients whose level of consciousness progresse to hard sedation. The possibility that the patient may come into a deeper state, such as general anesthesia, must be considered, and liberate measures by credentialed anesthesia care providers must be available. (2)

These make acceptableed practices provide guidelines for RN who manage the care of patients receiving moderate sedation/analgesia. Patient selection for moderate sedation/analgesia should be based upon established criteria developed through interdisciplinary collaboration by dint of health care professionals. The pattern of monitoring used with patients who receive moderate sedation/analgesia, the medications fix uponed and the interventions taken must be within the legally defined view of practice for perioperative RN (3)

Certain patients are not candidates for moderate sedation/analgesia monitored from RNs. Such patients may require more extensive sedation and should be identified, monitored, and managed by the agency of credentialed anesthesia care providers, surgeon or other physicians. (4)

approveed PRACTICE I

Registered cherishs should understand the goals and objectives of moderate sedation/analgesia.

1 The primary goal of moderate sedation/analgesia is to remodel the patient's anxiety and discomfort. Moderate sedation/analgesia also can facilitate cooperation between the patient and caregivers. (5) Moderate sedation/analgesia effects a condition in which the patient exhibits a bring lowed level of consciousness and an altered perception of pain moreover retains the ability to rejoin appropriately to verbal and/or tactile stimulation and maintains protective reflexes

2 The RN should be knowledgeable about the following desired issues when moderate sedation/analgesia medications are administered:

* alteration of mood;

* enhanced cooperation;

* alteration in perception of pain;

* maintenance of consciousness;

* maintenance of intact protective reflexes;

* minimal variation of vital signs;

* near degree of amnesia; and

* a rapid, safe recur to activities of daily living. (6)

3 The RN may be responsible for administering ordered medications based forward the patient's response and according to established protocols and defined liberty of practice. Adequate preoperative patient preparation and verbal reassurances from the RN facilitate the desired imports of moderate sedation/analgesia and may allow for a decrease in the dosages of opioids and sedatives. (7)

commended PRACTICE II

The RN managing the nursing care of the patient receiving moderate sedation/analgesia should have no other responsibilities that would require leaving the patient unattended or compromising continuous patient monitoring during the procedure

1 There should be an additional RN serving as the circulating nurture during any procedure in which a patient receives moderate sedation/analgesia. Continuous monitoring of the patient's physiological and psychological status by way of a competent RN leads to early detection of potential complications and increases the likelihood of positive issues (8)

RECOMMENDED PRACTICE III

The RN should be clinically in point possessing the skills necessary to manage the nursing care of the patient receiving moderate sedation/analgesia.

1 Health care facilities should provide or make available competency-based education programs for all RN who manage the care of patients receiving moderate sedation/analgesia. These programs should include a competency-validation proces for evaluating and documenting RNs' demonstration of relevant knowledge, skills, and abilities. Standardized competency-based programs establish baseline educational requirements and make secure comparable training throughout a facility. Evaluation and documentation of ability should occur on a periodic basis according to the health care facility's policies and manner of proceedings and according to regulatory requirements. (9)