The American Society for Gastrointestinal Endoscopy has revised its guidelines for safety in the gastrointestinal endoscopy unit (Calderwood 2014). The guideline focuses on multiple facets of patient and staff safety: facilities, staffing, infection control, and sedation.
The section on facilities focuses on ensuring adequate space and equipment are provided to facilitate the procedures, patient recovery, storage, and infection control measures. More complex procedures should be assigned to larger procedure rooms with space for more specialized equipment and additional staff. One thing we like is their position that there should be a written plan for traffic patterns within the unit.
The section on infection control discusses hand hygiene, use of PPE, safe medication practices, and topics related to safe handling of potentially contaminated equipment, reusable medical equipment, and terminal cleansing issues. It is recommended that a qualified staff member must be responsible for implementation of a specific infection prevention plan. The section on safe medication practices focuses heavily on infection prevention.
They have recommendations for staffing before, during and after endoscopic procedures and for qualifications and training of staff.
Like any procedure, a “timeout” for verification of correct patient and procedure is necessary. Actual marking of the site is not required for endoscopic procedures because endoscopy does not involve lateral right-left distinction levels such as those found in spinal procedures or those done on multiple structures such as fingers or toes. Before starting an endoscopic procedure, the patient, staff, and performing physician should verify the correct patient and procedure to be performed.
The section on sedation discusses equipment, medications, monitoring, and staffing. Regarding personnel during moderate sedation, a nurse should monitor the patient and can perform interruptible tasks. If more technical assistance is required, a second assistant (nurse, licensed practical nurse [LPN], or unlicensed assistive personnel [UAP]) should be available to join the care team.
The ASGE position on use of capnography is that there is inadequate data to support the routine use of capnography when moderate sedation is the target. Our own warning is that the “target” of moderate sedation is often overshot and some patients inadvertently receive deep sedation. While the evidence base for use of capnography in this setting may be limited, it only takes one case of a disaster related to oversedation to destroy whatever other good work you’ve done. Capnography is rapidly becoming a standard of care whenever patients are being given intravenous sedation or opioids.
Lastly, they have a section on management of emergencies and need for a plan for transfer of patients to higher level facilities where necessary.
Calderwood AH, Chapman FJ, Cohen J, et al for the ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointestinal Endoscopy 2014; article in press published 30 Jan 2014
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