Conscious sedation: a quality management project

Conscious sedation provides effective pain control and can relieve anxiety associated with procedures. The increased use of this modality has prompted the American Academy of Pediatrics to develop national guidelines that emphasize the need for patient monitoring to ensure patient safety. A policy was developed that incorporated continuous monitoring of patients and frequent documentation of physiological measures before, during, and after procedures. All procedures over a 2-month period in the outpatient (n = 19) and inpatient (n = 24) pediatric oncology units that required midazolam and fentanyl were retrospectively analyzed. A nonrandom sample of one third of the inpatient procedures (n = 8) was also observed to assess the dynamics of monitoring and recording. Procedures, including recovery time, lasted an average of 69 minutes, with longer recovery periods recorded for the outpatient unit. Nurses, particularly on the inpatient unit, were not always able to provide continuous monitoring through recovery because of the demands of other patient assignments. This study suggests that to realistically meet the needs of the patients and the institution's responsibility, the current guidelines may need to be reconsidered to allow more nursing discretion in patient monitoring and/or the nurse's patient care assignment must be more flexible to allow for changing demands.