A risk management audit: are we complying with the national guidelines for sedation by non-anaesthetists?
OBJECTIVE
To assess the effect of a preprinted form in ensuring an improved and sustained quality of documentation of clinical data in compliance with the national guidelines for sedation by non-anaesthetists.


METHODS
The process of retrospective case note audit was used to identify areas of poor performance, reiterate national guidelines, introduce a post-sedation advice sheet, and demonstrate improvement.


METHODS
Emergency Department, Musgrove Park Hospital, Taunton.


METHODS
Forty seven patients requiring sedation for relocation of a dislocated shoulder or manipulation of a Colles' fracture between July and October 1996 and July and October 1997.


METHODS
Evidence that the following items had been documented: consent for procedure, risk assessment, monitored observations, prophylactic use of supplementary oxygen, and discharging patients with printed advice. Case note review was performed before (n = 23) and after (n = 24) the introduction of a sedation audit form. Notes were analysed for the above outcome measures. The monitored observations analysed included: pulse oximetry, respiratory rate, pulse rate, blood pressure, electrocardiography, and conscious level.


RESULTS
Use of the form significantly improved documentation of most parameters measured.


CONCLUSIONS
Introduction of the form, together with staff education, resulted in enhanced documentation of data and improved conformity with national guidelines. A risk management approach to preempting critical incidents following sedation, can be adopted in this area of emergency medicine.
Nicol
M F
MF
Accident and Emergency Department, Royal Devon and Exeter Hospital, Wonford.
D016292:Procedural Sedation / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D008991:Monitoring, Physiologic / Q000592:standards / Q000639:trends; D009719:Nurse Anesthetists; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D017410:Practice Guidelines as Topic; D012308:Risk Management / Q000592:standards* / Q000639:trends; D012783:Shoulder Dislocation / Q000150:complications / Q000628:therapy; D006113:United Kingdom