Below I've cut and pasted recommendations on sedation personnel from ACEP
Clinical Policies Subcommittee on PSA that you might find helpful. The
article is well-worth reviewing.
Godwin SA et al. Clinical policy: Procedural sedation and analgesia in the
emergency department. *Ann Emerg Med*. 2014;63:247-258.
3. In patients undergoing procedural sedation and analgesia in the
emergency department, what is the minimum
number of personnel necessary to manage complications?
Level A recommendations. None specified.
Level B recommendations. None specified.
Level C recommendations. During procedural sedation and analgesia, a nurse
or other qualified individual should be present for continuous monitoring
of the patient, in addition to the provider performing the procedure.
Physicians who are working or consulting in the ED should coordinate
procedures requiring procedural sedation and analgesia with the ED staff.
Although it would seem reasonable that some patients with more complex
needs may require 2 physicians for the safe practice of procedural sedation
and analgesia in the ED, there is no evidence that specifically identifies
which cases, if any, require dual-physician involvement to prevent adverse
outcome. ED providers supervising procedural sedation and analgesia appear
capable of determining whether additional resources are necessary to
complete the procedure safely.
Future studies of the staffing necessary for procedural sedation
and analgesia should measure patient-centered outcomes, as well
as control for the type of medication and dosing administered,
type of procedure performed, type of medical personnel present,
patient comorbidities, and current clinical condition.
*Mark G. Roback, M.D.*
Professor of Pediatrics & Emergency Medicine
Director, Division of Emergency Medicine
University of Minnesota Children's Hospital
M653 East Building
Minneapolis, MN 55454
On Wed, Nov 19, 2014 at 7:45 AM, Vincent Tamariz <[log in to unmask]>
> We have had the same pushback and unfortunately Anesthesia In our
> institution has prevailed. I have worked at University Medical Center in
> Las Vegas and Saint Rose Hospital and one MD sedation with nurse monitoring
> was the standard. I of course agree with the one MD course, we never had an
> On Tue, Nov 18, 2014 at 4:09 PM Bernard Dannenberg <
> [log in to unmask]>
> > A straw poll to all members
> > We have written a new policy for deep sedation in our Pediatric Emergency
> > Department.
> > The following sentence has raised significant resistance by our
> > department:
> > > The physician administering deep sedation may also perform the
> > if a qualified ED registered nurse (RN) is present to continuously
> > the patient.
> > Their argument is that not one academic institution they contacted would
> > permit this.
> > Naturally I am suspicious. CMS guidelines appear to allow that one
> > provider can administer the sedation if a qualified nurse is present to
> > monitor the patient.
> > The California Department of Public Health has issued the following
> > clarification in July 2013
> > http://www.cdph.ca.gov/certlic/facilities/Documents/LNC-AFL-13-17.pdf
> > Can you respond to me directly what your institution is allowing you to
> > A. 2 physicians need to be present: One performs the sedation, the other
> > performs the procedure
> > B. 1 physician can administer the sedation and perform the procedure if a
> > qualified RN is monitoring the patient
> > I will tabulate the answers and distribute them back to the group.
> > Thank you for your assistance
> > Bernard Dannenberg, MD, FAAP, FACEP
> > Clinical Associate Professor
> > Davies Family Director, Pediatric Emergency Medicine
> > Division of Emergency Medicine
> > Department of Surgery
> > Stanford University School of Medicine
> > Lucile Packard Children’s Hospital
> > 300 Pasteur Drive
> > Alway Building M-121
> > Stanford, CA 94305
> > (650) 721 2450 FAX: (650) 723-0121
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