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PROCEDURAL SEDATION IN THE EMERGENCY DEPARTMENT – HOW WELL TRAINED ARE OUR STAFF?
  1. M Currer,
  2. T Trudeau,
  3. H Laura
  1. Emergency Department, Victoria Hospital, Kirkcaldy, Fife, Cupar, Fife, UK

Abstract

Objectives & Background Over recent years,our middle grade cover has become more variable in terms of seniority and experience. In addition, we have undergone a rapid turnover of nursing staff, with more senior staff being replaced by highly motivated but less experienced nurses. Historically, there has been little formal teaching on procedural sedation, with most staff picking up skills “on the job”. However, with changing staffing profile coupled with recently published guidance, we felt a more structured approach was required.

Methods Emergency Department (ED) medical and nursing staff of all grades were asked to complete an on-line survey in order to determine levels of confidence, and aspects of sedation where they felt knowledge could be improved.

Results We received 38 responses, 17 from senior doctors (consultants, ST 4–6 and equivalent) 12 from junior doctors (all other grades) 9 from nursing staff. 31 of 38 (81%) felt that more teaching on sedation would be beneficial. All those answering “no” were senior doctors.

Responders were asked to rate their confidence in pre procedural assessment, use and selection of medications, airway management, patient monitoring and safe discharge of patients. There was unsurprisingly considerable variation between groups. However, use and selection of medications was notably lower in all groups.

In the free text options, topics commonly cited were pharmacology, identifying and managing complications and need for scenario/simulation sessions.

Conclusion The results of this survey were utilised to inform development of a teaching programme for all staff in the department, consisting of written material, case based tutorials and subsequent in-situ simulation sessions.

Teaching packs are slightly different for nurses and medical staff but focus on patient selection; drug choice with notes on pharmacokinetics and pharmacodynamics, potential side effects and complications and important interactions; monitoring, and criteria for stopping close monitoring and for discharge.

Case based tutorials are aimed at all staff, with scope for varying discussion topics according to the learners needs.

The department already runs regular in – situ simulation sessions, and some standard sedation scenarios have been added to these sessions.

In future, we plan to develop an on-line module for staff to undertake with a self assessment component.

Table 1

Confidence Levels for aspects of procedural sedation

  • Trauma

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