Standards of practice in UK emergency departments before, during and after conscious sedation

The agents used for conscious sedation are well known to have potentially serious complications. It is recommended that patients receiving them should be objectively monitored until it is deemed safe. An audit of our departmental practices led us to conduct a national questionnaire to determine how we compared with other units in the UK.

All 211 UK emergency departments (EDs) seeing >40,000 patients/year were contacted and asked to take part in a telephone questionnaire. Interviewees were asked questions regarding which agents were used within their department, the types and duration of monitoring, whether or not patients were fasted, what consent was recorded, the number of staff present and who they were, and what follow-up arrangements were used.

183 departments (87%) completed the questionnaire. Opiates (77%) and benzodiazepines (97%) were the most commonly used agents. Heart rate/blood pressure monitoring (95%), ECG (86%) and pulse oximetry (97%) were used in the majority of cases. Other monitoring modalities, particularly neurological, were either used or documented infrequently. 112 departments (61%) monitored their patients for a set time (4-360 min; mean 97 min). The remainder were monitored until the patient scored a certain Glasgow Coma Score or was subjectively deemed fit. Only 24 departments (13%) ensured that their patients were fasted. 62 departments (34%) did not formally record either written or verbal consent. 80 departments (44%) had 2 members of staff present; the remainder had a minimum of 3. All departments had at least 1 ED doctor and nurse. 174 departments (95%) used fracture clinic follow-up. For conscious sedation, 51 departments (28%) had set proformas and 54 departments (30%) had set policies.

Certain practices were applied in most departments but none were universal, with most being subject to wide variation. The local results reflected this, suggesting that a variation may exist both within and between individual units.