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RCEM Audit Finds UK Emergency Departments Provide Safe Sedation, Despite Poor Documentation

Nearly half of adults sedated in Emergency Departments (EDs) did not have their consent recorded, according to an audit by the Royal College of Emergency Medicine.

 

Royal College of Emergency Medicine

The report, released today, audited 8845 adults presenting to 190 EDs and shows that sedation procedures are not being correctly documented.

The audit monitors documented care against the standards and aims to drive clinical practice forward by helping clinicians examine the work they do while recognising excellence.

However, the report finds that various monitoring standards are not being met. It shows:

  • in 44% of cases audited the level of sedation was not recorded – the intended level should be decided and recorded before the procedure
  • the standard for pre-procedural assessment recording was only met in a quarter of the instances audited
  • levels of patient satisfaction was only recorded in 15% of cases
  • poor data capture of which staff were present during sedation

Dr Clifford Mann, President of the Royal College of Emergency Medicine said: "This was a challenging audit with challenging results and shows there is work to be done. It is unacceptable from both a patient and clinical risk perspective that nearly half of patients did not have their consent recorded."

More positively, the report finds that in over 95% of cases patients suffered no adverse events during sedation. In the majority of cases where adverse events did occur, no admission or escalation of care was required. Significantly, no deaths were recorded as a consequence of sedations performed in EDs.

Dr Mann said: "Whilst there is much good practice occurring, the results are a clear indicator that a step change is required in the way sedation is practiced and recorded."

Dr Mann believes that meeting sedation standards is vital for both hospitals and patients: "Good quality sedation enhances the patient's experience, and can benefit hospitals by reducing admissions, pressure on theatre and costs.

"Delivery of safe sedation is a key component of the skill-set of any emergency medicine (EM) physician. However we must ensure that standards are met, with full and accurate documentation of procedures".

The College's President-elect, Dr Taj Hassan, said that findings of the report indicated a problem with data capture rather than practice: "Previous audit topics have highlighted deficiencies in documentation – these audit findings may be similarly related to shortfalls in documentation rather than in practice and we urge EDs to investigate this locally."

As well as ensuring adequate documentation of pre-procedural assessment and of patients' informed consent, the report recommends that EDs have protocols in place to ensure that staff are qualified to perform sedation and that they use a safe sedation checklist.

Dr Hassan said: "We would strongly encourage all EDs to take on board our recommendations, and consider using a rapid cycle audit methodology, which will help them to meet performance standards and improve patient care."

 

Source: RCEM

 

 

RCEM Audit Finds UK Emergency Departments Are Poorly Documenting Safe Sedation Procedures

 
 
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The Operating Theatre Journal, OTJ, is published monthly and distributed to every hospital operating theatre department in the UK. The distribution includes both the National Health Service and the Private Sector.

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