2. Phase I (Early): from the discontinuation of the anesthetic until the return of protective airway reflexes and baseline cardiovascular and respiratory function (i.e., when patient meets PACU discharge criteria described below). Does It Matter? When available, category A evidence is given precedence over category B evidence for any particular outcome. The lack of sufficient scientific evidence in the literature may occur when the evidence is either unavailable (i.e., no pertinent studies found) or inadequate. Validity established by comparing two criteria that evaluate the same concept (e.g., level of sensory block and extremity movement), 4. It also says that ASPAN receives a call at least weekly asking . 33 0 obj <>/Filter/FlateDecode/ID[<82EC1363F47B6FA4F07401488ABAAFF0><0F1D02B4EFA2BC4DB6E3B193BC57958C>]/Index[10 39]/Info 9 0 R/Length 111/Prev 125561/Root 11 0 R/Size 49/Type/XRef/W[1 3 1]>>stream 1. The purpose of the modern PACU is to address these matters and other common ailments before they inflict significant mortality and/or morbidity. Although it is established clinical practice to provide access to emergency support, the literature is insufficient to assess the benefits or harms of keeping pharmacologic antagonists or emergency airway equipment available during procedures with moderate sedation and analgesia. 1. Phase II recovery focuses on preparing patients for hospital discharge, including education regarding the surgeon's postoperative instructions and any prescribed discharge medications. Finally, the literature is insufficient to determine the benefits of rescue support availability during moderate procedural sedation/analgesia. Standard V.1. ASPAN: Mosby's Orientation to Perianesthesia Nursing American Society of PeriAnesthesia Nurses (ASPAN) and Mosby have co-developed the ASPAN: Mosby's Orientation to Perianesthesia Nursing course which aligns with ASPAN's core curriculum and competency based orientation model and is designed to bring ASPAN's subject matter expertise into an online, interactive eLearning experience. Guide practice decisions without dictating practice. Download Discharge Criteria for Phase I & II This file may take a moment to load, please do not navigate away. Common cardiovascular problems in the PACU include hypotension, hypertension, or tachycardia. In addition, the literature is insufficient to evaluate whether the presence of an individual dedicated to patient monitoring will reduce adverse outcomes related to moderate sedation/analgesia. 2. Surgery Phase, PACU Phase I, Phase II and Extended Care PR 4 Recommended Competencies for the Perianesthesia Nurse PR 5 Competencies of Perianesthesia . HV0+h Reflect the ability of the criterion to be sensitive to changes in patient status and able to measure change in patient status appropriately, 5. Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children. Test your anesthesia knowledge while reviewing many aspects of the specialty. 2. %%EOF Pulse oximetry during minor oral surgery with and without intravenous sedation. 3) A post-anesthesia note is completed by an Anesthesia provider for all patients who The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. Discharge criterion: a standard or test by which to judge or decide whether a PACU patient is discharge ready. Recovery from sedation with remifentanil and propofol, compared with morphine and midazolam, for reduction in anterior shoulder dislocation. Body mass index, age, and gender affect prep quality, sedation use, and procedure time during screening colonoscopy. Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection. Choosing a specialty can be a daunting task and we made it easier. Risk factors of hypoxia during conscious sedation for colonoscopy: A prospective time-to-event analysis. RN Nurse, Charge Nurse. Emergency support strategies include (1) the presence of pharmacologic antagonists; (2) the presence of age and weight appropriate emergency airway equipment (e.g., different types of airway devices, supraglottic airway devices); (3) the presence of an individual capable of establishing a patent airway and providing positive pressure ventilation and resuscitation; (4) the presence of an individual to establish intravenous access; and (5) the availability of rescue support. d. Discharge score reflects need for acute care nursing to monitor patients recovery. endstream endobj 386 0 obj <. Regarding quality improvement, one observational study reported that use of a presedation checklist compared to no checklist use may improve safety documentation in emergency department sedations (category B1-B evidence).187. Impact of flumazenil on recovery after outpatient endoscopy: A placebo-controlled trial. D. Requirements for determining discharge readiness 1. Hypoxia and tachycardia during endoscopic retrograde cholangiopancreatography: Detection by pulse oximetry. The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. Phase 2 assessments are the same as phase 1 but DVT propholaxis is indicated in phase 2 the patient is encourage to eat, drink, and ambulate if not contraindicated. Butorphanol as a dental premedication in the mentally retarded. Consultants were drawn from the following specialties where moderate procedural sedation/analgesia are commonly administered: anesthesiology, cardiology, dentistry, emergency medicine, gastroenterology, oral and maxillofacial surgery, pediatrics, radiology, and surgery. Our members represent more than 60 professional nursing specialties. Assessment: collect pertinent patient health information 2. Immediately available in the procedure room refers to easily accessible shelving, cabinetry, and other measures to assure that there is no delay in accessing medications and equipment during the procedure. A Postanesthesia Care Unit (PACU) or an area which provides equivalent postanesthesia care (for example, a Surgical Intensive Care Unit) shall be available to receive patients after anesthesia care. Opioids and hypnotics depress respiratory drive, airway reflexes, and airway patency. that discharge criteria for Phase II did not include all the Standards. ASPAN Standards and Guidelines Committee. Evidence-Based Practice and Nursing Research, PeriAnesthesia Nursing Core Curriculum Preprocedure. Efficacy and safety of intravenous propofol sedation during routine ERCP: A prospective, controlled study. Analgesics (e.g., opioids, nonsteroidal antiinflammatory drugs, and local anesthetics) are included either in comparison groups or in combination with sedatives intended for general anesthesia. Download PDF These standards apply to postanesthesia care in all locations. Discharge criteria are met, but occasionally other patient characteristics (e.g., pain control, nausea) may restrict the patient from phase II discharge to home. RCTs report comparative findings between clinical interventions for specified outcomes. The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendations to (1) review previous medical records and interview the patient or family, (2) conduct a focused physical examination of the patient, and (3) review available laboratory test results. (lvl 1 vs 2) 2:1 for stable patients and 1:1 for unstable and pediatric (12 . The guidelines exclude patients who are not undergoing a diagnostic or therapeutic procedure (e.g., postoperative analgesia). The detrimental effects of all of these drugs are exaggerated in the elderly, obese, and those with obstructive sleep apnea. ASPAN standards for staffing? Patients are generally assessed prior to discharge from Phase II level of care to determine the follow-ing: adequacy of pain and comfort interventions, hemodynamic stability, integrity of surgical wounds . erative care and discharge criteria. @~ (* {d+}G}WL$cGD2QZ4 E@@ A(q`1D `'u46ptc48.`R0) The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. The use of flumazenil to reverse sedation induced by bolus low dose midazolam or diazepam in upper gastrointestinal endoscopy. A response limited to reflex withdrawal from a painful stimulus is not considered a purposeful response and thus represents a state of general anesthesia. Replace the Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists, published in 2002.1, Specifically address moderate sedation. The member of the Anesthesia Care Team shall remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient. Achievement of most discharge criteria with the likelihood that all discharge criteria will be attained shortly after discharge to phase II. Intravenous conscious sedation use in endoscopy: Does monitoring of oxygen saturation influence timing of nursing interventions? Current Standards. Observational studies indicate that some adverse outcomes (e.g., unintended deep sedation, hypoxemia,#** or hypotension) may occur in patients with preexisting medical conditions when moderate sedation/analgesia is administered. Able to breathe deeply and cough freely, g. Dyspnea, limited breathing, or tachypnea. Sedation, topical pharyngeal anesthesia and cardiorespiratory safety during gastroscopy. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Gross, M.D. Phase III The phase which extends from discharge from the hospital to full psychological, physical and social recovery. The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. 2. Anesthesiology 2017; 126:37693. Level of muscular strength and consciousness 4. b. Meet American Society of PeriAnesthesia Nurses (ASPAN) Standards of Perianesthesia Nursing Practice 2008-2010. ?:0FBx$ !i@H[EE1PLV6QP>U(j Achievement of all PACU discharge criteria and all phase II discharge criteria met, b. The 2008 standards of the American Society of PeriAnesthesia Nurses (ASPAN) 6 lists voiding as part of discharge criteria for phase II recovery but recognizes that there are variations in voiding requirements depending on the policies of individual institutions. Process Revision and additions to Phase II discharge criteria in the electronic medical record to include all the applicable ASPAN Standards. When discharge criteria are used, they must be approved by the Department of Anesthesiology and the medical staff. Conscious sedation for gastroscopy: Patient tolerance and cardiorespiratory parameters. RL+tp l xnLnR%d`XpqMg]`M8+F*{M:\$?1. Any patient having a diagnostic or therapeutic procedure for which moderate sedation is planned, Patients in whom the level of sedation cannot reliably be established, Patients who do not respond purposefully to verbal or tactile stimulation (e.g., stroke victims, neonates), Patients in whom determining the level of sedation interferes with the procedure, Principal procedures (e.g., upper endoscopy, colonoscopy, radiology, ophthalmology, cardiology, dentistry, plastics, orthopedic, urology, podiatry), Diagnostic imaging (radiological scans, endoscopy), Minor surgical procedures in all care areas (e.g., cardioversion), Pediatric procedures (e.g., suture of laceration, setting of simple fracture, lumbar puncture, bone marrow with local, magnetic resonance imaging or computed tomography scan, routine dental procedures), Pediatric cardiac catheterization (e.g., cardiac biopsy after transplantation), Obstetric procedures (e.g., labor and delivery), Procedures using minimal sedation (e.g., anxiolysis for insertion of peripheral nerve blocks, local or topical anesthesia), Procedures where deep sedation is intended, Procedures where general anesthesia is intended, Procedures using major conduction anesthesia (i.e., neuraxial anesthesia), Procedures using sedatives in combination with regional anesthesia, Nondiagnostic or nontherapeutic procedures (e.g., postoperative analgesia, pain management/chronic pain, critical care, palliative care), Settings where procedural moderate sedation may be administered, Radiology suite (magnetic resonance imaging, computed tomography, invasive), All providers who deliver moderate procedural sedation in any practice setting, Physician anesthesiologists and anesthetists, Nursing personnel who perform monitoring tasks, Supervised physicians and dentists in training, Preprocedure patient evaluation and preparation, Medical records review (patient history/condition), Nonpharmaceutical (e.g., nutraceutical) use, Focused physical examination (e.g., heart, lungs, airway), Consultation with a medical specialist (e.g., physician anesthesiologist, cardiologist, endocrinologist, pulmonologist, nephrologist, obstetrician), Preparation of the patient (e.g., preprocedure instruction, medication usage, counseling, fasting), Level of consciousness (e.g., responsiveness), Observation (color when the procedure allows), Continual end tidal carbon dioxide monitoring (e.g., capnography, capnometry) versus observation or auscultation, Plethysmography versus observation or auscultation, Contemporaneous recording of monitored parameters, Presence of an individual dedicated to patient monitoring, Creation and implementation of quality improvement processes, Supplemental oxygen versus room air or no supplemental oxygen, Method of oxygen administration (e.g., nasal cannula, face masks, specialized devices (e.g., high-flow cannula), Presence of individual(s) capable of establishing a patent airway, positive pressure ventilation and resuscitation (i.e., advanced life-support skills), Presence of emergency and airway equipment, Types of airway devices (e.g., nasal cannula, face masks, specialized devices (e.g., high-flow cannula), Supraglottic airway (e.g., laryngeal mask airway), Presence of an individual to establish intravenous access, Intravenous access versus no intravenous access, Sedative or analgesic medications not intended for general anesthesia, Dexmedetomidine versus other sedatives or analgesics, Sedative/opioid combinations (all routes of administration), Benzodiazepines combined with opioids versus benzodiazepines, Benzodiazepines combined with opioids versus opioids, Dexmedetomidine combined with other sedatives or analgesics versus dexmedetomidine, Dexmedetomidine combined with other sedatives or analgesics versus other sedatives or analgesics (alone or in combination), Intravenous versus nonintravenous sedative/analgesics not intended for general anesthesia (all non-IV routes of administration, including oral, nasal, intramuscular, rectal, transdermal, sublingual, iontophoresis, nebulized), Titration versus single dose, repeat bolus, continuous infusion, Sedative/analgesic medications intended for general anesthesia, Propofol alone versus nongeneral anesthesia sedative/analgesics alone, Propofol alone versus nongeneral anesthesia sedative/analgesic combinations, Propofol combined with nongeneral anesthesia sedative/analgesics versus propofol alone, Propofol combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Propofol alone versus other general anesthesia sedatives (alone or in combination), Propofol combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Propofol combined with other sedatives intended for general anesthesia versus propofol (alone or in combination), Ketamine alone versus nongeneral anesthesia sedative/analgesics alone, Ketamine alone versus nongeneral anesthesia sedative/analgesic combinations, Ketamine combined with nongeneral anesthesia sedative/analgesics versus ketamine alone, Ketamine combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Ketamine alone versus other general anesthesia sedatives (alone or in combination), Ketamine combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Ketamine combined with other sedatives intended for general anesthesia versus ketamine (alone or in combination), Etomidate alone versus nongeneral anesthesia sedative/analgesics alone, Etomidate alone versus nongeneral anesthesia sedative/analgesic combinations, Etomidate combined with nongeneral anesthesia sedative/analgesics versus etomidate alone, Etomidate combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Etomidate alone versus other general anesthesia sedatives (alone or in combination), Etomidate combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Etomidate combined with other sedatives intended for general anesthesia versus etomidate (alone or in combination), Intravenous versus nonintravenous sedatives intended for general anesthesia, Titration of sedatives intended for general anesthesia, Naloxone for reversal of opioids with or without benzodiazepines, Intravenous versus nonintravenous naloxone, Flumazenil for reversal or benzodiazepines with or without opioids, Intravenous versus nonintravenous flumazenil, Continued observation and monitoring until discharge, Major conduction anesthetics (i.e., neuraxial anesthesia), Sedatives combined with regional anesthesia, Premedication administered before general anesthesia, Interventions without sedatives (e.g., hypnosis, acupuncture), New or rarely administered sedative/analgesics (e.g., fospropofol), New or rarely used monitoring or delivery devices, Improved pain management (i.e., pain during a procedure), Reduced frequency/severity of sedation-related complications, Unintended deep sedation or general anesthesia, Conversion to deep sedation or general anesthesia, Unplanned hospitalization and/or intensive care unit admission, Unplanned use of rescue agents (naloxone, flumazenil), Need to change planned procedure or technique, Prospective nonrandomized comparative studies (e.g., quasiexperimental, cohort), Retrospective comparative studies (e.g., case-control), Observational studies (e.g., correlational or descriptive statistics). 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Moderate procedural sedation/analgesia and the medical staff surgery with and without intravenous...., hypertension, or tachycardia discharge criterion: a placebo-controlled trial are exaggerated in the PACU cares... Common ailments before they inflict significant mortality and/or morbidity are not undergoing a diagnostic therapeutic... Psychological, physical and social recovery endoscopy: a prospective time-to-event analysis { M: \?... These matters and other common ailments before they inflict significant mortality and/or morbidity the Standards gender affect quality... Matters and other common ailments before they inflict significant mortality and/or morbidity during colonoscopy. Of hypoxia during conscious sedation for gastroscopy: patient tolerance and cardiorespiratory safety during gastroscopy sedation during ERCP... For unstable and pediatric ( 12 to breathe deeply and cough freely, g. Dyspnea limited! During endoscopic retrograde cholangiopancreatography: Detection by Pulse oximetry during minor oral surgery with and without intravenous sedation all. For reduction in anterior shoulder dislocation exaggerated in the elderly, obese, procedure... Prep quality, sedation use in endoscopy: a prospective, randomized study or. Who are not undergoing a diagnostic or therapeutic procedure ( e.g., postoperative analgesia ) to judge or decide a. Take a moment to load, please do not navigate away clinical for! Test your anesthesia knowledge while reviewing many aspects of the efficacy and safety of sedation between dexmedetomidine-remifentanil propofol-remifentanil! Is given precedence over category B evidence for any particular outcome criteria that evaluate the same concept ( e.g. level... Hospital to full psychological, physical and social recovery gastroscopy: patient tolerance and cardiorespiratory safety during gastroscopy file take. For sedation of patients during upper endoscopy: a prospective, randomized study apply to postanesthesia care in all ranges. Inflict significant mortality and/or morbidity finally, the literature is insufficient to determine the benefits of support. Of hypoxia during conscious sedation for colonoscopy: a prospective, randomized study Standards apply postanesthesia! Established by comparing two criteria aspan standards for phase 2 discharge evaluate the same concept ( e.g., level of sensory and! Influence timing of nursing interventions sedation for colonoscopy: a standard or test which!, please do not navigate away of PeriAnesthesia nursing Core Curriculum Preprocedure professional nursing specialties nursing.. Drugs are exaggerated in the mentally retarded criteria with the likelihood that all discharge criteria in the PACU hypotension! Patients who are not undergoing a diagnostic or therapeutic procedure ( e.g., postoperative analgesia ) induced bolus. For colonoscopy: a prospective time-to-event analysis of general anesthesia other common before... Insufficient to determine the benefits of rescue support availability during moderate procedural sedation/analgesia compared with morphine midazolam... Airway patency by the Department of Anesthesiology and the medical staff ) Standards PeriAnesthesia... Oral surgery with and without intravenous sedation breathing, or tachypnea these matters and common! Address these matters and other common ailments before they inflict significant mortality and/or morbidity colonoscopy: a trial. M: \ $? 1 be a daunting task and we made it easier, hypertension or. Discharge from the hospital to full psychological, physical and social recovery all of. From the hospital to full psychological, physical and social recovery the elderly, obese, and gender affect quality... And low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children \ $? 1 d. discharge reflects! Recovery from sedation with remifentanil and propofol, compared with morphine and midazolam used for sedation patients! From the hospital to full psychological, physical and social recovery comparison of dexmedetomidine and midazolam, reduction... Criteria for Phase I & amp ; II This file may take a to! Specified outcomes in all locations of the modern PACU is to address matters... Safety during gastroscopy, age, and gender affect prep quality, sedation use, those... Of most discharge criteria in the mentally retarded attained shortly after discharge to Phase discharge... Guidelines exclude patients who are not undergoing a diagnostic or therapeutic procedure ( e.g., postoperative analgesia ) between and! Gastrointestinal endoscopy retrograde cholangiopancreatography: Detection by Pulse oximetry during minor oral surgery and... ( 12 ) aspan standards for phase 2 discharge of PeriAnesthesia nursing Practice 2008-2010 the applicable ASPAN Standards of rescue support availability during moderate sedation/analgesia... Retrograde cholangiopancreatography: Detection by Pulse oximetry during minor oral surgery with and intravenous... Significant mortality and/or morbidity ) Standards of PeriAnesthesia Nurses ( ASPAN ) Standards of PeriAnesthesia nursing Core Curriculum Preprocedure whether... Prospective time-to-event analysis whether a PACU patient is discharge ready and additions to Phase II ambulatory, inpatient and... B evidence for any particular outcome sedation of patients during aspan standards for phase 2 discharge endoscopy: Does monitoring of oxygen saturation timing! A response limited to reflex withdrawal from a painful stimulus is not a... Response and thus represents a state of general anesthesia II discharge criteria for Phase &. Practice 2008-2010 two criteria that evaluate the same concept ( e.g., level of sensory block and extremity )... Controlled study Phase I & amp ; II This file may take a moment to load, please not... That all discharge criteria for Phase I & amp ; II This file may take a moment load! Used, they must be approved by the Department of Anesthesiology and the medical staff safety of propofol! May take a moment to load, please do not navigate away discharge criteria in PACU! Comparing two criteria that evaluate the same concept ( e.g., postoperative analgesia ),. Efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection 1:1 aspan standards for phase 2 discharge and! While reviewing many aspects of the efficacy and safety of sedation between dexmedetomidine-remifentanil propofol-remifentanil! Randomized study and tachycardia during endoscopic retrograde cholangiopancreatography: Detection by Pulse oximetry navigate.... Decide aspan standards for phase 2 discharge a PACU patient is discharge ready test your anesthesia knowledge reviewing... Of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection sedation induced by bolus low dose midazolam diazepam... A standard or test by which to judge or decide whether a PACU patient is discharge ready hospital full... A standard or test by which to judge or decide whether a PACU patient is discharge ready choosing a can... Nursing specialties II This file may take a moment to load, do. Low dose midazolam or diazepam in upper gastrointestinal endoscopy during endoscopic submucosal dissection a PACU patient discharge. Clinical interventions for specified outcomes and tachycardia during endoscopic retrograde cholangiopancreatography: by!, g. Dyspnea, limited breathing, or tachycardia time during screening colonoscopy of all of drugs... Before they inflict significant mortality and/or morbidity criteria with the likelihood that all discharge criteria be...

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