Standardizing Procedural Sedation Across a Large Healthcare System

When less invasive procedures don’t require local, regional or general anesthesia, proceduralists can use procedural sedation to help block patients’ pain, discomfort and anxiety. However, proceduralists must be proficient in sedation levels to avoid fluctuations in patients’ consciousness, and in extreme instances, the need for resuscitation.

And with more than 100,000 cases using procedural sedation throughout Cleveland Clinic’s health system, our Procedural Sedation Committee oversees and applies several safeguards to ensure the delivery of exceptional care.

“Any time a patient is sedated, there’s an increased risk for complications,” says staff anesthesiologist Basem Abdelmalak, MD, Director of the Center for Sedation and co-chair of Cleveland Clinic’s Procedural Sedation Committee. “Knowing the potential risks, we take extraordinary precautions to ensure our patients are safe when using any form of sedation. There’s an intricate balance between keeping patients comfortable while selecting the appropriate sedation option.”

What’s involved

The committee uses a multipronged approach to ensure the safety and efficacy of procedural sedation across all of Cleveland Clinic.

• Standardized privileging requirements by specialty.
• Mandatory annual training and competencies.
• Hands-on simulation training available to hone skills and prepare for unexpected rescues.
• Practice guidelines to reduce variation.
• Review of the patient’s medical record prior to the procedure to identify potential risks.
• Use of a discharge score process in the recovery area to determine home readiness.
• Ongoing monitoring of reported safety events to identify trends and adjust practices as needed.

“Sedation is a continuum of care,” Dr. Abdelmalak adds. “And that care has to be patient-specific. By applying standardized guidelines, proceduralists can select the appropriate sedation, or in complex instances, consult with an anesthesiologist to determine the safest approach.”

Nearly 600 physicians and 1,500 registered nurses at Cleveland Clinic follow these best practices to be approved to perform procedural sedation.

Gastroenterologist Talal Adhami, MD, knows the benefits. As co-chair of the Procedural Sedation Committee, Dr. Adhami explains, “We see incredible value in our increased scrutiny of our procedural sedation practices. With these additional safeguards, we’ve seen a decline in our over-sedation rates — and that makes a significant impact on our patients’ safety.”

The Procedural Sedation Committee’s work and collaboration exemplifies the team of teams approach where physicians, nurses, accreditation and data specialists, administrators, professional staff affairs and fire safety specialists collectively contribute to the advancement of patient safety.