What’s New in the Patient Safety World
March 2014
New ASGE Endoscopy Safety Guidelines
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.
References:
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
http://www.giejournal.org/article/S0016-5107%2813%2902698-9/fulltext
Print “PDF
version”
http://www.patientsafetysolutions.com/