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Related Experiment Videos

Conscious sedation: a quality management project

P J Ross1, D Fochtman

  • 1Queen's Medical Center, Honolulu, Hawaii, USA.

Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses
|July 1, 1995
PubMed
Summary
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Pediatric oncology nurses struggle with continuous patient monitoring during conscious sedation due to heavy workloads. Guidelines may need adjustment for better patient safety and nursing flexibility.

Area of Science:

  • Pediatric Oncology
  • Anesthesiology
  • Nursing Practice

Background:

  • Conscious sedation is increasingly used for pediatric pain and anxiety management during procedures.
  • The American Academy of Pediatrics developed guidelines for continuous patient monitoring during conscious sedation.
  • A policy was implemented requiring continuous monitoring and frequent documentation of physiological measures.

Purpose of the Study:

  • To evaluate the feasibility of implementing continuous patient monitoring during conscious sedation in pediatric oncology units.
  • To assess the challenges nurses face in adhering to monitoring guidelines.
  • To identify potential areas for policy revision.

Main Methods:

  • Retrospective analysis of procedures using midazolam and fentanyl in outpatient and inpatient pediatric oncology units over two months.

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  • Inclusion of 19 outpatient and 24 inpatient procedures.
  • Nonrandom observation of one-third of inpatient procedures (n=8) to assess monitoring dynamics.

    • Main Results:

    • Procedures averaged 69 minutes, with longer recovery times in the outpatient unit.
    • Nurses, especially on inpatient units, could not always provide continuous monitoring during recovery.
    • High nursing workload and other patient assignments interfered with continuous monitoring.

    Conclusions:

    • Current conscious sedation monitoring guidelines may be difficult to implement realistically in busy pediatric oncology settings.
    • Reconsideration of guidelines to allow more nursing discretion in monitoring is suggested.
    • Increased nursing flexibility in patient assignments is needed to meet monitoring demands and ensure patient safety.