Improving safety of sedation for transoesophageal echocardiography

This project aimed to develop solutions for optimal, safe sedation, in transoesophageal echocardiagraphy (TOE). Prescription and dosage errors arise from physicians failing to approach experienced operators for assistance, and lack of familiarity with Trust TOE guidelines. We conducted a retrospective analysis of 319 patients who were referred for TOE over a nine-month period. Data was obtained from the hospital medical records and database. Midazolam doses exceeding Trust guidelines were being administered, posing unnecessary risks for under 18 and over 60 year-olds especially. This quality improvement project intervened by: 1. Adding a paediatric section with sedation dosage advice to Trust guidelines; 2. Increasing awareness of the need for lower sedation doses in over 60 year-olds, by updating the pre-procedure checklist with an age and maximum recommended midazolam dose section. These changes were accepted following presentation of the audit at the monthly Clinical Governance Meeting, and early indications reported increased confidence in midazolam dosing and awareness of the risks of not following the guidelines. Operator confidence in these changes requires re-audit, in order to confirm the findings, and continue improvement to the Trust TOE guidelines and patient safety.