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psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors
December 09, 2020 - The patient did not need any further sedation during the intubation. … The intent was to place the patient in this case under light sedation with midazolam. … In most centers, light sedation can be performed without the supervision of an anesthesiologist or nurse … safety checklist ( 6 ), and it is divided into three checkpoint sections: before bronchoscopy, before sedation … There are no scientific publications on syringe labeling errors or sedation dose errors in bronchoscopy
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psnet.ahrq.gov/issue/5th-national-audit-project-nap5-accidental-awareness-during-general-anaesthesia-patient
October 01, 2014 - Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation … Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation … Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation
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www.ahrq.gov/hai/tools/mvp/sustainability/checklist.html
January 01, 2017 - the bed is at least 30 degrees from the horizontal position
Daily *
• Continue to conduct a sedation … spontaneous breathing trial (SBT)
Daily *
Daily Early Mobility
• Continue to conduct a sedation
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digital.ahrq.gov/sites/default/files/docs/resource/Logan_QMforColonoscopy_Narrative_v4.pdf
December 12, 2008 - SEDATION MEDICATIONS. Sedation medication(s) used and dosages are
documented.
a. … This includes procedures where no sedation medications
were used, where there was residual sedation … • No sedation medications were used is documented by the checkbox "No sedation
medications given" … If “No sedation medications given” is checked and sedation medications are
documented, then an error … SEDATION MEDICATIONS
#5. BOWEL PREP QUALITY
#6. DEPTH OF INSERTION
#7. EXAMINATION TIME
# 8.
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/daily-care-processes-guide.pdf
January 01, 2017 - • Target a sedation level and perform a structured assessment of sedation level using a
validated … sedation scale (e.g., Richmond agitation sedation scale [RASS] or Riker
sedation-agitation scale [SAS … Set a target sedation goal of no or light sedation and
work to achieve that level. … protocol targeting light sedation
and incorporating daily sedation interruptions. … Light sedation targets required provider
education, standard sedation practices with a revised sedation
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psnet.ahrq.gov/node/851971/psn-pdf
July 31, 2023 - Procedural sedation and risk of aspiration
Esophagogastroduodenoscopy (EGD) is the procedure of choice … Without adequate sedation, patients often gag
and pull the endoscope out of the stomach. … Pulmonary aspiration during procedural sedation: a
comprehensive systematic review. … Major adverse events and relationship to Nil per Os
status in pediatric sedation/anesthesia outside … the operating room: a report of the Pediatric Sedation
Research Consortium.
-
www.ahrq.gov/hai/tools/mvp/modules/cusp/action-plan-trip-fac-guide.html
February 01, 2017 - A significant barrier to mobilizing patients occurs when patients are under sedation. … Ask:
What is the current practice related to sedation? … ( Perhaps no order was given to halt sedation. … No assessment was performed to indicate the patient needed lighter sedation.) … How often are daily SATs performed on all patients receiving sedation?
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/actionplan-trip-facguide.docx
January 01, 2017 - A significant barrier to mobilizing patients occurs when patients are under sedation. … ASK:
What is the current practice related to sedation? … (Perhaps no order was given to halt sedation. … No assessment was performed to indicate the patient needed lighter sedation.) … How often are daily SATs performed on all patients receiving sedation?
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/intro-early-mobility-slides.pptx
January 01, 2017 - physical, occupational, and respiratory therapists; physicians; and administrators
Interrupt daily sedation … and minimize sedative use
Daily sedative interruptions and targeting light sedation will help patients … remain alert and cooperative
Assess sedation and delirium with structured scales
Routinely assessing … the patient’s cognitive function helps target lighter sedation levels and treat delirium
Screen for … were main barriers
Endotracheal tube Sedation Inotropes Femoral
Line Respiratory
Rate Pulmonary Artery
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psnet.ahrq.gov/issue/widespread-misinterpretation-advance-directives-and-portable-orders-life-sustaining
December 18, 2019 - January 1, 2000
Threats to safety during sedation outside of the operating room and the … event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation … : a consensus document from the World SIVA International Sedation Task Force.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/sustainability/sustainability-checklist.docx
January 01, 2017 - head of the bed is at least 30 degrees from the horizontal position
Daily*
Continue to conduct a sedation … receiving a spontaneous breathing trial (SBT)
Daily*
Daily Early Mobility
Continue to conduct a sedation
-
psnet.ahrq.gov/web-mm/sudden-collapse-during-upper-gastrointestinal-endoscopy-expect-unexpected
September 25, 2024 - ranging from 0-9%, depending on the underlying etiology of the stricture. 5 Complications related to sedation … Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy. … Prevalence and Predictors of Adverse Events during Procedural Sedation Anesthesia-Outside the Operating … Sedation-related complications in gastrointestinal endoscopy. … Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc . 2018; 87: 327-37.
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pbrn.ahrq.gov/hai/tools/mvp/modules/vae/overview-off-ventilator-slides.html
February 01, 2017 - Minimize sedation level.
Use SAT with validated sedation scale daily. … Manage ventilated patients without sedation whenever possible.
16. … Slide 25: 2014 SHEA Compendium Update 16
Interrupt sedation once a day (SAT). … Use continuous sedation if boluses exceed 3 per hour. … Avoid deep sedation; instead, target awake or alert.
-
pcmh.ahrq.gov/hai/tools/mvp/modules/vae/overview-off-ventilator-slides.html
February 01, 2017 - Minimize sedation level.
Use SAT with validated sedation scale daily. … Manage ventilated patients without sedation whenever possible.
16. … Slide 25: 2014 SHEA Compendium Update 16
Interrupt sedation once a day (SAT). … Use continuous sedation if boluses exceed 3 per hour. … Avoid deep sedation; instead, target awake or alert.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/datameasures-guide.pdf
January 01, 2017 - Sedation Scale Definitions .......................................................................... … Sedation Scale Definitions
RATE FACTOR DETAILED DESCRIPTION
Sedation Scale
Percentage of
RASS/SAS … levels
Sedation Scale:
Light to Moderate
Sedation (RASS
Actual = {-2, -3} or
SAS Actual = {3 … SBT Definitions
Sedation Scale
Table 5. … Sedation Scale Definitions
Delirium Assessment
Table 6.
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psnet.ahrq.gov/perspective/conversation-sharon-k-inouye-md-mph
December 01, 2012 - A "no sedation" strategy is also referred to as an analgosedation strategy. … Using this strategy it is possible to achieve adequate pain and sedation control with an opiate-based … Dexmedetomidine vs midazolam for sedation of critically ill patients. JAMA. 2009;301:489-499. … Reducing patient harm from sedation, immobility, and delirium. [Available at]
20. … C
Choice of Sedation
Avoid benzodiazepines.
-
psnet.ahrq.gov/node/43627/psn-pdf
November 12, 2014 - Project (NAP5) on accidental
awareness during general anaesthesia: patient
experiences, human factors, sedation … Project (NAP5) on accidental awareness
during general anaesthesia: patient experiences, human factors, sedation
-
effectivehealthcare.ahrq.gov/products/migraine-emergency/research
November 27, 2012 - The risk of sedation following administration of metoclopramide or neuroleptic agents was 17 percent. … The most common short-term side effects for triptans were skin reactions, local reactions, and sedation … For patients receiving DHE, the most common side effects were skin and local reactions, sedation, digestive
-
psnet.ahrq.gov/issue/outcomes-after-out-hospital-endotracheal-intubation-errors
July 20, 2010 - Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation … June 27, 2011
Incidence and nature of adverse events during pediatric sedation/anesthesia … for procedures outside the operating room: report from the Pediatric Sedation Research Consortium.
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/intro-early-mobility-facguide.docx
January 01, 2017 - The second intervention is interrupting daily sedation and minimizing sedative use. … Heavily sedated patients are not able to safely participate in a mobility program, and so targeting light sedation … and interrupting sedation daily enable them to remain alert and cooperative. … Using structured assessments of sedation and delirium through validated scales might more effectively … target light sedation levels for your patient and mitigate and treat delirium.