Procedural sedation and analgesia practices in the emergency centre

Abstract

Introduction Procedural sedation and analgesia allows the clinician to safely and efficiently administer sedation, analgesia, anxiolysis and sometimes amnesia to facilitate the performance of various procedures in the emergency centre. The aim of this study is to determine current sedation practices, common indications and major obstacles in selected emergency centres across Southern Gauteng, South Africa, with a view to improving future standards and practices. Methods This was a prospective, questionnaire based, cross-sectional interview of emergency centre managers or their designee of selected private-sector and public-sector hospitals in Southern Gauteng. Results Overall, 17 hospitals completed the interview, nine (53%) public-sector and eight (47%) private-sector hospitals, with 36% of hospitals being aligned to an academic institute. All hospitals performed procedural sedation in their emergency centre. Forty seven percent of managers had between ten and 19 years of clinical experience post internship. Although eleven (64.7%) managers achieved a postgraduate qualification in emergency medicine, only seven (41%) were accredited with a Fellowship of the College of Emergency Medicine (FCEM) qualification and only three (17.7%) centres employed three or more specialists. The majority of centres (52.3%) performed between ten and 30 procedures per month requiring sedation. Staff training in the practice of procedural sedation was mostly obtained internally (52.9%), from in-house seniors. Essential drugs, procedure monitors, resuscitation equipment and protocols were all available in 70.6% of centres. Conclusion Although the safe practice and awareness of procedural sedation and analgesia in both public-sector and private-sector emergency centres in Southern Gauteng appears to be on the increase, there is still a need to enhance practitioner training and promote awareness of current local and international trends, protocols and recommendations.

Implementing essential diagnostics-learning from essential medicines: A scoping review

“…Human resources-related enablers for the implementation of EML reported include sufficient capacity of health care workers 138, 155 , adequate training provided to health care workers 58, 156 , and availability of health care workers 57 .…”

“…A similar barrier was identified in the implementation of the EML. Unavailability of guidelines was the most prominent theme within the barriers related to relationship with norms and standards for the EML implementation 35,66,86,106,110,116,154,166,143,59,106,119,131,143,155,167 . Other barriers unique to the EML included incompliance to guidelines 50,53,131,149,153,166,168,169 , incompliance to national EMLs 48,68,79,132,145,170 , lack of national EMLs in facilities 128,171 , disconnect between guidelines on treatment protocols 47,75 , disconnect between policy, guidelines and practice 46,167 , and lack of standard operating procedures 135 .…”

“…Barriers unique to the EML included lack of price regulations or pricing policy 78,86,89,[108][109][110]141,148,174,180 , incompliance to regulations 38,46,88,133,145,176,185 , lack of structured guidelines for registration and control 72,73,116,126,186 . Other barriers included lack of policies 73,153,155 , inadequate policies that provide control and use of medicines 44,53,187 , long registration process 68,146,170 , restriction on the use of medicines 41,142 , lack of political will in implementing policies 159 , lack of a regulatory body for certifying and professionalizing medical, logistical companies 159 , and inadequate procedures 149 .…”

‘This won’t hurt a bit!’ – A descriptive review of health care professionals’ pharmacological management of pain in minor trauma

“…Alternatively, it is possible that lignocaine may not have been used in the management/ suturing of lacerations as they were superficial and did not require closure or because of the practice of procedural sedation, which is growing in popularity within ECs in Africa. 28 Ketamine IMI was administered on four occasions as procedural sedation, all to paediatric patients in situations where lignocaine was not used.…”

Sedación para procedimientos en el servicio de urgencias

“…Si bien la práctica segura y la conciencia de la sedación y la analgesia en los procedimientos son necesarios, lo primordial es que el personal tenga la mejor capacitación para proveer un procedimiento seguro y eficaz (9,30,48,49,50).…”