1. A descriptive monitoring study of a non-anesthetist sedation quality program
- Author
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María Sonsoles Leal Ruiloba, Rafael Cabadas Avión, Ismail Wi Hijazi, María Ojea Cendón, Santiago Vázquez López, María Aurora Baluja González, and Julián Álvarez-Escudero
- Subjects
medicine.medical_specialty ,Midazolam ,Process improvement ,Digestive endoscopy ,Program monitoring ,Clinical Protocols ,Bradycardia ,Medicine ,Humans ,Endoscopy, Digestive System ,Prospective Studies ,Difficult airway ,Quality Indicators, Health Care ,Quality of Health Care ,Gynecology ,business.industry ,Gastroenterology ,General Medicine ,Middle Aged ,Quality dimensions ,Fentanyl ,Patient Safety ,Deep Sedation ,Hypotension ,business ,Adjuvants, Anesthesia ,Program Evaluation - Abstract
espanolIntroduccion: la sedacion mejora sensiblemente la calidad de la endoscopia digestiva, aunque puede tener complicaciones graves. Metodos: protocolo multidisciplinar en base a la joint comission que defina el protocolo de sedacion por no anestesiologos. Se excluyen pacientes ASA 4 o con via aerea dificil, pruebas complejas y sedacion profunda. Controlamos la calidad en base al analisis de 9 indicadores. Tambien se monitorizan las pruebas incompletas para valorar eficacia. Resultados: la seguridad del paciente se establece en base a una incidencia de complicaciones muy baja, con una incidencia de eventos respiratorios de 1,07. Ademas, se encuentra una baja incidencia de hipotension y bradicardia, al igual que del dolor durante y despues de la endoscopia y una incidencia menor del 0,5% de ingresos no esperados. Los indicadores de calidad medidos nos indican la evolucion de los resultados del programa. Conclusiones: la monitorizacion continuada de los programas de sedacion en endoscopia permiten controlar las diferentes dimensiones de la calidad e implementar medidas que mejoren el proceso. EnglishIntroduction: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. Methods: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. Results: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. Conclusions: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement.
- Published
- 2018