ppg-gdch-anesot-03.09 moderate and deep sedation

8/13/2019 Ppg-gdch-Anesot-03.09 Moderate and Deep Sedation

1/21

GULF DIAGNOSTIC CENTER

HOSPITAL

ANESTHESIA POLICY Policy No: MED-ANS-P003/09

TITLE: MODERATE & DEEP SEDATIONI!" D#$" : M#%c '009

R"(iio) No*: 0'

D"+#%$,")$ : M"ic#l R"(iio) D#$" : .!ly '0'S"c$io) : A)"$"i# N"$ R"(iio) : .!ly '01

Di$%i2!$io) : Ho+i$#l i" P#4" o5 6

MODERATE & DEEP SEDATION

APPRO7AL SHEET

P%"+#%" 2y:

N#," Si4)#$!%" D#$"

Dr. Thomas Patrick o!"

#$a% &!$sth$sia ' ()$rati!" Th$at$r

R"(i"8" 2y:

N#," Si4)#$!%" D#$"

Dr. #assa! &* +ah%i

#$a% o, -r"$r/ D$)artm$!t

+r. 0h$r &ra1i

2a*it/ +a!a"$r

A++%o(" 2y:

N#," Si4)#$!%" D#$"

Dr 3ma% 4assi! &* 5ahma!i

+$%ica* Dir$ctor

+rs. 6ama* 7a%%ora

8o9:o!%$r ' #os)ita* Dir$ctor

Appendix: Yes [ ] No [ ]


2/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" ' o5 6

DOCUMENT AMENDMENT RECORD SHEET

D#$" D"c%i+$io) o5 C#)4" P#4" E55"c$"R"(iio)

N!,2"%

;


3/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 3 o5 6



4/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 1 o5 6

* DEFINITIONS

=.=. -$%atio! r$s*ts ,rom th$ a%mi!istratio! o, a m$%icatio! that )ro%c$s a %$)r$ss$%

*$B$* o, co!scios!$ss. -$%atio! ma/ r$s*t i! th$ *oss o, )rot$ctiB$ r$,*$E$s. Th$r$

ar$ ,or s)$ci,ica**/ %$,i!$% *$B$*s o, s$%atio!. $B$*s o, s$%atio!F s$$ &))$!%iE GF

-$%atio! *$B$*s.

'* POLICY

>.=. At is th$ )o*ic/ o, th$ hos)ita* that th$s$ "i%$*i!$s a))*/ to a** *ocatio!s 1ithi! th$

hos)ita* 1h$r$ mo%$rat$ a!% %$$) s$%atio! is a%mi!ist$r$%.

>.>. This )o*ic/ i!c*%$s th$ )ractic$ "i%$*i!$s ,or s$%atio! H/ !o!9a!$sth$sio*o"ists.

>.@. A!%iBi%a*s a%mi!ist$ri!" s$%atio! mst H$ cr$%$!tia*$% a!% )riBi*$"$% H/ th$ ID89

#os)ita*.

'*3** P"%o))"l

>.@.=.=. Th$ s$ o, mo%$rat$ a!% %$$) s$%atio! sha** i!c*%$ a! i!%iBi%a*

)riBi*$"$% to %ir$ct s$%atio! a!% a cr$%$!tia*$% mo!itori!" assista!t.

>.@.=.>. Th$ )h/sicia! a%mi!ist$ri!" mo%$rat$ a!% %$$) s$%atio! mst haB$ th$

a))ro)riat$ )riBi*$"$s a!% H$ Ja*i,i$% to r$sc$ )ati$!ts ,rom %$$)s$%atio! or $B$! a!$sth$sia a!% mst H$ com)$t$!t to ma!a"$ a!

!staH*$ car%ioBasc*ar s/st$m as 1$** as a com)romis$% air1a/ a!%

i!a%$Jat$ oE/"$!atio! a!% B$!ti*atio! i!c*%i!" &8- c$rti,icatio! ,or

a%*t )ati$!ts or P&- c$rti,icatio! ,or )$%iatric )ati$!ts.

>.@.=.@. Th$ )h/sicia! )r$scriHi!" %r"s ,or mo%$rat$ a!% %$$) s$%atio! sho*%

haB$ a! !%$rsta!%i!" o, th$ir )harmaco*o"/ as 1$** as th$

)harmaco*o"/ o, a!ta"o!ist m$%icatio!s.

>.@.=.C. Th$ cr$%$!tia*$% mo!itori!" assista!t K5LM mst H$ trai!$% i! Hasic

37I. Th$ )o*ic/ %o$s !ot a))*/ to th$ ,o**o1i!" )ati$!tsF

@.>.=. Pati$!ts haBi!" a! a!$sth$sio*o"ist )roBi%i!" s$%atio!. &!$sth$sio*o"ists ar$

"oB$r!$% H/ th$ sta!%ar%s o, car$ $staH*ish$% H/ th$ %$)artm$!t o,

a!$sth$sio*o"/.

@.>.>. Pati$!ts r$c$iBi!" a!Eio*/tic or a!a*"$sic a"$!tsN 1hich ar$ a%mi!ist$r$%

roti!$*/ to a**$Biat$ )ai! a!% a"itatio! K$.". )r$o)$ratiB$ s$%atio! or

)osto)$ratiB$ a!a*"$siaM.



5/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" o5 6

@.>.@. Pati$!ts 1ho r$c$iB$ a!/ *oca* a!$sth$siaN a!% ?Q or *$ss !itros oEi%$ i!

oE/"$! 1ith !o oth$r s$%atiB$s or a!a*"$sics H/ a!/ rot$.

@.@. Th$ )h/sicia! )riBi*$"$% to %ir$ct s$%atio! is r$s)o!siH*$ ,or th$ sa,$t/ a!% 1$**

H$i!" o, th$ )ati$!t a!% sha** $!sr$ that this )o*ic/ is oHs$rB$%. A! $ith$r $*$ctiB$ or

$m$r"$!c/ )roc$%r$sN i, circmsta!c$s 1arra!t %$Biatio! ,rom this )o*ic/N th$

r$aso! 1i** H$ %ocm$!t$% i! th$ )ati$!tRs m$%ica* r$cor%.

3*1* Ai$io)#l %"+o)i2ili$i" i)cl!"

@.C.=. 8om)*$tio! o, histor/ a!% )h/sica* stats

@.C.>. 8om)*$tio! o, i!,orm$% co!s$!t

@.C.@. (r%$ri!" o, th$ m$%icatio!sN %osa"$ a!% rot$ o, a%mi!istratio!

@.C.C. 3m$r"$!c/ i!t$rB$!tio!s as !$$%$%

@.. Th$ cr$%$!tia*$% mo!itori!" assista!tRs r$s)o!siHi*it/ is to mo!itor )h/sio*o"ic

)aram$t$rs a!% assist i! a!/ s))ortiB$ or r$sscitatiB$ m$asr$s as r$Jir$%.

@..=. Th$ mo!itori!" assista!t sha** a*soF

@..=.=. O$ ,ami*iar 1ith th$ $,,$cts o, th$ %r"s s$%.

@..=.>. 7!o1 ho1 to r$co"!iS$ air1a/ oHstrctio! a!% corr$ct it.@..=.@. 7!o1 ho1 to mo!itor r$Jir$% )aram$t$rsN ho1 to r$co"!iS$

aH!orma*iti$s i! th$ r$Jir$% )aram$t$rs a!% ho1 to %$a* 1ith it.

@..=.C. O$ aH*$ to ma!a"$ B$!ti*atio! 1ith a s$*,9i!,*ati!" Ha" Ba*B$ mask.

@..=.. O$ ,ami*iar 1ith this )o*ic/.

1* PROCEDURE

C.=. P%"-+%oc"!%" E(#l!#$io)F & )r$9s$%atio! ass$ssm$!t mst H$ )$r,orm$% H/ a

Ja*i,i$% i!%iBi%a* a!% %ocm$!t$% i! th$ m$%ica* r$cor% ,or $ach )ati$!t H$,or$

a%mi!ist$ri!" s$%atio!. This i!c*%$sF

C.=.=. 5$*$Ba!t histor/ Kmaor or"a! s/st$msN s$%atio! a!% a!$sth$sia histor/Nm$%icatio!sN a**$r"i$sN *ast ora* i!tak$M.

C.=.>. aHorator/ t$sti!" "i%$% H/ !%$r*/i!" co!%itio!s a!% )ossiH*$ $,,$ct o!

)ati$!tsU ma!a"$m$!t.

C.=.@. 5$$Ba*atio! imm$%iat$*/ H$,or$ s$%atio! is a%mi!ist$r$%.

C.=.C. &t this tim$ h$


6/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" ; o5 6

C.=.C.=.>. Th$ risksN H$!$,itsN *imitatio!sN a*t$r!atiB$sN )ot$!tia* com)*icatio!s

a!% o)tio!s ar$ %iscss$% 1ith th$ )ati$!tN his or h$r ,ami*/ or thos$

1ho mak$ %$cisio!s ,or th$ )ati$!t.

C.=.C.=.@. Th$ i!,orm$% co!s$!t is %ocm$!t$% i! th$ m$%ica* r$cor%.

C.=.C.=.C. Th$ !rs$ mst B$ri,/ th$ )r$s$!c$ o, this %ocm$!tatio! H$,or$

a%mi!istratio! o, s$%atio!.

1**1*'* P%"-P%oc"!%" F#$i)4

C.=.C.>.=. Th$ &-& Ii%$*i!$s ,or Pr$ ()$ratiB$ ,asti!" ar$ ma!%ator/. Ks$$

&))$!%iE AAM

1**1*3* P#$i")$ "l"c$io):

C.=.C.@.=. Pati$!ts mst H$ scr$$!$% ,or )ot$!tia* risk ,actors 1ith r$s)$ct to

a!/ )harmaco*o"ica* a"$!ts s$*$ct$%.

C.=.C.@.>. Pati$!ts 1i** H$ scr$$!$% ,or risk ,actors ti*iSi!" th$ &-& Ph/sica*

-tats 8*assi,icatio! K-$$ &))$!%iE AAAM

C.=.C.@.@. This %$cisio! o! 1hich a"$!t to s$ mst H$ Has$% o! th$ "oa*s o,

s$%atio!N t/)$ o, )roc$%r$ a!% co!%itio! a!% a"$ o, )[email protected]. Pati$!ts co!si%$r$% a))ro)riat$ ,or co!scios s$%atio! ar$ &-& A

a!% &-& AA.

C.=.C.@.. Pati$!ts i! &-& c*ass AAA or AV )r$s$!t s)$cia* )roH*$ms 1hich ma/

!$c$ssitat$ a co!s*tatio! H/ a m$mH$r o, th$ a!$sth$sia %$)artm$!t.

C.=.C.C. E

s$%atio! is H$i!" a%mi!ist$r$%M

C.=.C.C.=. &! o)$rati!" taH*$N tro**$/ or chair that ca! H$ $asi*/ ti*t$%.

C.=.C.C.>. Lo!9i!BasiB$ 55 mo!itor

C.=.C.C.@. P*s$ oEim$t$rC.=.C.C.C. 8o!ti!os 38I sha** H$ s$% ,or )ati$!t r$Jiri!" co!ti!os

38I mo!itori!"

C.=.C.C.. & sorc$ a!% m$a!s ,or )roBi%i!" s))*$m$!ta* oE/"$! K!asa*

ca!!*aN mask $tc.M

C.=.C.C.W. & sorc$ o, sctio! K1a** or )ortaH*$M.

C.=.C.C.. 3m$r"$!c/ air1a/ $Ji)m$!t KmasksN amH9Ha"N air1a/sN $tc.M

C.=.C.C.;. 3m$r"$!c/ 8rash 8art 1ith %$,iHri**ator mst H$ i! c*os$

)roEimit/.

C.=.C.C.X. 3m$r"$!c/ %r"s i!c*%i!" AV ,*i%s a!% r$B$rsa* %r"s

C.=.. S$#55i)4 =& mi!imm o, t1o )$rso!!$* mst H$ i!Bo*B$% i! th$ car$ o, )ati$!t!%$r"oi!" s$%atio! %ri!" th$ $!tir$ )roc$%r$M



7/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" > o5 6

C.=..=. th$ )h/sicia! 1ho )$r,orms th$ )roc$%r$ a!%

C.=..>. th$ i!%iBi%a* 1hos$ r$s)o!siHi*it/ is %ir$ct$% o!*/ to th$ )ati$!tF to

a%mi!ist$r m$%icatio!N to mo!itor th$ )ati$!tN a!% to oHs$rB$ th$

)ati$!tRs r$s)o!s$ to Hoth th$ s$%atio! a!% th$ )roc$%r$.

1**;* P#$i")$ +%"+#%#$io)/ +%"- +%oc"!%" ,#)#4",")$:

C.=.W.=. &! ass$ssm$!t o, th$ )ati$!tRs )r$9)roc$%r$ &*%r$t$ scor$ 1i** H$

)$r,orm$% H/ a 5L. :or th$ )ati$!t 1ho is sch$%*$% ,or a! $*$ctiB$

)roc$%r$N th$ aBai*aHi*it/ a!% a))ro)riat$!$ss o, tra!s)ortatio!

,o**o1i!" th$ )roc$%r$ mst H$ B$ri,i$% )rior to th$ a%mi!istratio! o,

s$%atio!.

C.=.W.>. A!,orm$% co!s$!t ,or )roc$%r$ a!% s$%atio! is co!,irm$%.

C.=.W.@. Pr$9)roc$%r$ )ati$!tN s$%atio!< )ai! scor$ a!% car%iac

mo!itori!" ar$ oHtai!$% a!% r$cor%$%.C.=.W.;. V$ri,/ )ati$!t has r$s)o!siH*$ a%*t )roBi%i!" tra!s)ortatio! )ost

)roc$%r$.

1**>* I)$%#-P%oc"!%"

C.=..=. & mo!itori!" 5L sha** H$ )r$s$!t to co!ti!os*/ ass$ss )ati$!tUs

co!%itio! a!% ,aci*itat$ )ati$!t sa,$t/ a!% com,ort.

C.=..>. Th$ mo!itori!" 5L sha** haB$ !o r$s)o!siHi*it/ oth$r tha! %ir$ct car$ o,

th$ )ati$!t i! J$stio!.

C.=..@. & B$!os acc$ss sit$ 1i** H$ mai!tai!$% thro"hot th$ )roc$%r$ a!%

r$coB$r/ )$rio% as i!%icat$% H/ )h/sicia!.

C.=..C. +$%icatio!s sha** H$ a%mi!ist$r$% o!*/ !%$r th$ %ir$ctio! o, th$r$s)o!siH*$ )h/sicia!.

C.=... &** m$%icatio!s a%mi!ist$r$% mst H$ r$cor%$% K%r"N %os$N tim$ a!%

rot$M.

C.=..W. Th$ amo!t a!% m$a!s o, oE/"$! s))*/ sha** H$ %ocm$!t$%.

C.=... Vita* si"!s K38IN -a(>N #5 a!% 55M ar$ r$cor%$% $B$r/ 9=? mi!t$s.

$B$* o, co!scios!$ss Ks$%atio! sca*$M is r$cor%$% $B$r/ = mi!t$s.

C.=..;. V$rHa* r$assra!c$ to )ati$!t ,r$J$!t*/ thro"hot th$ )roc$%r$. Th$

)ati$!tUs h$a% )ositio!N air1a/ a!% ch$st $Ecrsio! mst H$

co!ti!os*/ mo!itor$%. Th$ )ati$!t is r$)ositio!$% as !$c$ssar/ to

$!sr$ a%$Jat$ s)o!ta!$os ti%a* Bo*m$.

C.=..X. Y!to1ar% r$actio!s or s%%$!


8/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 6 o5 6

C.=..=?. A! cas$ o, a!/ $m$r"$!c/ ca** h$*) ,rom &!$sth$sia D$)artm$!t or

a*arm 8o%$ O*$

C.=..==. Tota* ,*i% sha** H$ r$cor%$%.

C.=..=>. Y!sa*N !a!tici)at$% or a%B$rs$ $B$!ts sha** H$ %$scriH$% a!%

r$cor%$%.

C.=..=@. Th$ )ati$!tRs co!%itio! at th$ co!c*sio! o, th$ )roc$%r$ sha** H$

ass$ss$% a!% %ocm$!t$%.

C.=..=C. Ys$ o, Pro)o,o* ,or s$%atiB$ )r)os$s i! th$ i!stittio! is *imit$% to th$

,o**o1i!" )$rso!s

&!$sth$sio*o"ists. Z+D[

&!$sth$sia T$ch!icia!s !%$r th$ %ir$ct s)$rBisio! o, th$

&!$sth$sio*o"ist.

Lo! &!$sth$sio*o"ist )h/sicia!s 1ho ca! %$mo!strat$ $ith$r ,orma*

trai!i!" i! its a%mi!istratio! or c*i!ica* $E)$ri$!c$Z1ith 1ritt$!

r$,$r$!c$s att$sti!" to sch[ ' a )roB$! track r$cor% i! a%mi!istratio!

th$r$o,.ZTh$ &!$sth$sio*o"ist sha** %ir$ct*/ oHs$rB$ c*i!ica*

)ractic$


9/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 9 o5 6

m$%icatio! %os$ a!% $B$r/ = mi!t$s ,or W? mi!t$s th$r$a,t$r to

$!sr$ r$9s$%atio! 1i** !ot occr.

C.=.;.. Th$ )ati$!t ma/ H$ %ischar"$% ,rom th$ r$coB$r/ ar$a 1ith a 1ritt$!

or%$r ,rom th$ )h/sicia! )roBi%i!" s$%atio!. Th$ 5LN !%$r th$

%ir$ctio! o, th$ )h/sicia!N ma/ %ischar"$ )ati$!ts 1h$! th$/ haB$ m$t

%ischar"$ crit$ria.

C.=.;.;. Th$ mo%i,i$% &*%r$t$sR scori!" s/st$m Ks$$ &))$!%iE AVM sha** H$ s$%

,or thos$ )ati$!ts %ischar"$% to th$ )ati$!t car$ !it K$.". i!)ati$!tsM.

Pati$!ts mst haB$ a scor$ o, ; or "r$at$r to H$ %ischar"$%.

C.=.;.X. Th$ +o%i,i$% Post &!$sth$sia Dischar"$ -cori!" -/st$m Ks$$ &))$!%iE

VM sha** H$ s$% ,or thos$ )ati$!ts %ischar"$% hom$. Pati$!ts mst haB$

a scor$ o, "r$at$r or $Ja* to X ,or %ischar"$ hom$.

C.=.;.=?. Th$ )h/sicia! )roBi%i!" s$%atio! 1i** H$ co!s*t$% r$"ar%i!"

r$ass$ssm$!t o, )ati$!t !ot m$$ti!" th$ aHoB$ crit$ria. -C hors a,t$r s$%atio!N a!%

a!/ a%%itio!a* i!strctio!s as )$r )h/sicia! K*ik$ %i$tar/ a!% m$%icatio!

i!strctio!sN )ost %ischar"$ actiBit/ i!strctio!s $tc.M

C.=.X.C. To Pati$!t 8ar$ Y!it. Th$ )ati$!t m$t th$ r$Jir$% scor$ o! +o%i,i$%

&*%r$t$Us scori!" s/st$m. Pati$!tUs mo!itori!" mst H$ co!ti!$% as )$r

that !itUs !rsi!" sta!%ar%.

C.=.X.. P$r,orma!c$ mo!itori!"C.=.X..=. 8ar$ )roBi%$rs mo!itor k$/ as)$cts o, mo%$rat$ a!% %$$) s$%atio!

as ot*i!$% i! this )o*ic/ i! or%$r to $!sr$ that )ati$!ts r$c$iBi!"

s$%atio! ar$ )roBi%$% th$ sam$ *$B$* o, sa,$ a!% $,,$ctiB$ car$

thro"hot th$ hos)ita*. Y!sa*N !a!tici)at$%N or a%B$rs$ $B$!ts

sha** H$ r$)ort$% to th$ Ja*it/ im)roB$m$!t %$)artm$!t. Th$s$

i!c*%$ Ht ar$ !ot *imit$% to th$ ,o**o1i!" i!%icatorsF

C.=.X..=.=. +a!a* i!t$rB$!tio! to s))ort air1a/


10/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 0 o5 6

C.=.X..=.. &%mi!istratio! o, a!/ r$B$rsa* a"$!tsN 3)i!$)hri!$ $tc.

* REFERENCES

.=. Practic$ Ii%$*i!$s ,or s$%atio! a!% &!a*"$sia O/ !o!9&!$sth$sio*o"istN &-& NA!c.N

=XX;N >@=9>@>

.>. &!$sth$sia a!% -$%atio! -ta!%ar%s a!% 5$"*atio!sN 8a*i,or!ia +$%ica* &ssociatio!.

;* RELATED DOCUMENTS

W.=. Po*ic/ o, co!scios s$%atio!

W.>. 8o%$ O*$ Po*ic/

W.@. Practic$ "i%$*i!$s ,or )r$o)$ratiB$ ,asti!"N &!$sth$sio*o"/ K=XXXMN X?N ;XW9X?

>* APPENDICES

>** A++")i I LE7EL OF SEDATION

.=.=. +i!ima* s$%atio! Ka!Eio*/sisMF & %r"9i!%c$% stat$ %ri!" 1hich )ati$!ts

r$s)o!% !orma**/ to B$rHa* comma!%s. &*tho"h co"!itiB$ ,!ctio! a!%

coor%i!atio! ma/ H$ im)air$%N B$!ti*ator/ a!% car%ioBasc*ar ,!ctio!s ar$!a,,$ct$%.

.=.>. +o%$rat$ s$%atio!


11/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" o5 6

5$comm$!%atio!s o! )r$o)$ratiB$ ,asti!" i! $*$ctiB$N h$a*th/ )ati$!ts 1$r$ iss$% H/ th$

&m$rica! -oci$t/ o, &!$sth$sio*o"/ K&-&M i! =XXX.

A!"$st$% mat$ria* +i!imm ,asti!" tim$

8*$ar *iJi%s > hrs

Or$ast mi*k C hrs

i"ht m$a*N i!,a!t ,orm*a a!% oth$r mi*k W hrs

#$aB/ m$a* ; hrs

>*3* A++")i IIIASA =A,"%ic#) Soci"$y o5 A)"$"iolo4y?

PHYSICAL STATUS CLASSIFICATION:

.@.=. 8*ass A Lo or"a!icN )h/sio*o"icN Hioch$mica* or )s/chiatric

%istrHa!c$. Lorma*N h$a*th/ )ati$!t.

.@.>. 8*ass AA +i%9mo%$rat$ s/st$mic %istrHa!c$^ ma/ or ma/ !ot H$ r$*at$%

to r$aso! ,or sr"$r/. K3Eam)*$sF h/)$rt$!sio!N %iaH$t$s m$**itsM

.@.@. 8*ass AAA -$B$r$ s/st$mic %istrHa!c$. K3Eam)*$sF si"!i,ica!t coro!ar/

art$r/ %is$as$N )oor*/ co!tro**$% h/)$rt$!sio!N %iaH$t$sM

[email protected]. 8*ass AV i,$ thr$at$!i!" s/st$mic %istrHa!c$. K3Eam)*$sF co!"$stiB$

h$art ,ai*r$N )$rsist$!t a!"i!a )$ctorisM

.@.. 8*ass V +oriH!% )ati$!t. itt*$ cha!c$ ,or srBiBa* i! !$Et >C hors.

-r"$r/ is *ast r$sort. K3Eam)*$F r)tr$% aH%omi!a* aortic a!$r/smNcatastro)hic i!trac$r$Hra* H*$$%i!"?

[email protected]. 8*ass 3 Pati$!t r$Jir$s $m$r"$!c/ )roc$%r$. K3Eam)*$F

a))$!%$ctom/N D'8 ,or !co!tro**$% H*$$%i!"M

>*1* A++")i I7 MODIFIED ALDRETE@S SCORE

>*1** Ac$i(i$y:

+sc*$ actiBit/ is ass$ss$% H/ oHs$rBi!" th$ aHi*it/ o, th$ )ati$!t to moB$ his 9 &H*$ to moB$ C $Etr$miti$s

= 9 &H*$ to moB$ > $Etr$miti$s? 9 Lot aH*$ to co!tro* a!/ $Etr$mit/



12/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" ' o5 6

>*1*'* R"+i%#$io):

5$s)irator/ $,,ici$!c/ $Ba*at$% i! a ,orm that )$rmits accrat$ a!% oH$ctiB$

ass$ssm$!t 1ithot com)*icat$% )h/sica* t$sts.

-cor$F

> 9 &H*$ to Hr$ath$ %$$)*/ a!% co"h

= 9 imit$% r$s)irator/ $,,ort K%/s)!$a or s)*i!ti!"M

? 9 Lo s)o!ta!$os r$s)irator/ $,,ort

>*1*3* Ci%c!l#$io):

Ys$ cha!"$s o, art$ria* H*oo% )r$ssr$ ,rom )r$9a!$sth$tic *$B$*.

-cor$F

> 9 -/sto*ic art$ria* )r$ssr$ H$t1$$! )*s or mi!s >?Q o, )r$9

a!$sth$tic *$B$* K5iBa95occi m$tho%M

= 9 -/sto*ic art$ria* )r$ssr$ H$t1$$! )*s or mi!s >?Q to ?Q o,

)r$9a!$sth$tic *$B$*

? 9 -/sto*ic art$ria* )r$ssr$ H$t1$$! )*s or mi!s =Q or mor$ o,)r$9a!$sth$tic *$B$*

>*1*1* Co)cio!)"

D$t$rmi!atio! o, th$ )ati$!tRs *$B$* o, co!scios!$ss

-cor$F

> 9 :** a*$rt!$ss s$$! i! )ati$!tRs aHi*it/ to a!s1$r J$stio!s a!%

ack!o1*$%"$ his 9 Lorma* ski! co*or a!% a))$ara!c$

= 9 &!/ a*t$ratio! i! ski! co*or^ )a*$N %sk/N H*otchN a!%ic$%N $tc.

? 9 :ra!k c/a!osis

&** ot)ati$!ts 1ho r$c$iB$ s$%atio! ,or a!/ )roc$%r$ mst H$ oHs$rB$% a!%mo!itor$% ,or a mi!imm o, = hor )rior to H$i!" %ischar"$% hom$. Vita*



13/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 3 o5 6

si"!s Kh$art rat$N r$s)irator/ rat$ a!% H*oo% )r$ssr$M ar$ r$cor%$% at = 9 @?

mi!t$ i!t$rBa*s.

>** A++")i 7 DISCHARGE SCORING SYSTEM

+$%ica* sta,, a))roB$% %ischar"$ crit$ria i!c*%$sF

..=. 8om)*$tio! o, &*%r$t$ scor$.

..>. &Hi*it/ to amH*at$ co!sist$!t 1ith Has$*i!$ ass$ssm$!t.

..@. &Hi*it/ to %$mo!strat$ a "a" r$,*$E.

..C. &Hi*it/ to r$tai! ora* ,*i%N as a))ro)riat$ to AP or%$rs

... Pai! mi!ima*.

..W. &Hi*it/ o, )ati$!t a!% hom$ car$ )roBi%$r to !%$rsta!% a** hom$ car$

i!strctio!s.

... ]ritt$! %ischar"$ i!strctio!s "iB$! to )ati$!t. > 9 (ccasio!a**/ %ro1s/^ $as/ to aros$

.W.@. @ 9 :r$J$!t*/ %ro1s/^ $as/ to aros$

.W.C. C 9 &s*$$)^ $as/ to aros$

.W.. 9 -om!o*$!t^ %i,,ic*t to aros$.

>*>* SEDATION AGITATION SCALE



14/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 1 o5 6

Th$ tar"$t is @9C.

2"lo8thr$$ K@M !$$% i!t$rB$!tio! K r$%ctio! o, s$%atio! D#)4"%o! A4i$#$io)

P**i!" at 3T tH$N tr/i!" to r$moB$ cath$t$rsN c*imHi!" oB$r H$% rai*sN

striki!" at sta,,N

thrashi!" si%$ to si%$

; 7"%y A4i$#$"

Do$s !ot ca*mN %$s)it$ ,r$J$!t B$rHa* r$mi!%i!" o, *imitsN r$Jir$s

)h/sica* r$strai!tsN

Hiti!" 3T tH$

A4i$#$"

&!Eios or mi*%*/ a"itat$%N att$m)ti!" to sit )N ca*ms %o1! to B$rHa*

i!strctio!s

1 C#l, & Coo+"%#$i(" 8a*mN a1ak$!s $asi*/N ,o**o1scomma!%s

3 S"#$"

Di,,ic*t to aros$N a1ak$!s to B$rHa* stim*i "$!t*$ shaki!" Ht %ri,ts

o,, a"ai!N

,o**o1s sim)*$ comma!%s

' 7"%y "#$"

&ros$s to )h/sica* stim*i Ht %o$s !ot comm!icat$ or ,o**o1

comma!%sN

ma/ moB$ s)o!ta!$os*/

U)#%o!#2l"

+i!ima* or !o r$s)o!s$ to !oEios stim*iN %o$s !ot comm!icat$

or ,o**o1

comma!%s


15/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" o5 6

o)4 #"% F#c" +#i) c#l"

' 3 1

;

:ac$s sca*$ ' !m$rica* sca*$F

=9@ !o!9 )harmaco*o"ica* tr$atm$!t a!% )ossiH*$ mi*% a!a*"$sic.

_`C i!,orm )h/sicia! a!% )harmaco*o"ica* i!t$rB$!tio!.

N!,"%ic +#i) c#l"

0 ' 3 1 ; > 6 9 0

?F !o )ai!

=?F 1orst )ossiH*$ )ai!

- 7i!#l A)#lo4!" Sc#l"B 7AS

0---------------------------------------------0 c, li)"-----------------------------------------0

?F !o )ai! =?F 1orst )ossiH*$ )ai!



16/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" ; o5 6

P#i) %"li"5 c#l"

0---------------------------------------------0 c, li)"-----------------------------------------0

?F !o r$*i$, =?F com)*$t$ r$*i$,

- NEONATAL PAIN ASSESSMENT SCALE =NIPS?: =Fo% N"o)#$" !+ $o y"#%?

EHA7IORA

L CUES0 '

F#ci#l

E+%"io)

5$*aE$% msc*$s9

5$st,* ,ac$N !$tra*

3E)r$ssio!

Irimac$9ti"ht ,acia*

msc*$sN ,rro1$%

Hro1N chi!N a1

K!$"atiB$ ,acia*

$E)r$ssio!9!os$Nmoth a!% Hro1M

999999

C%y 2i$t Lot cr/i!"

]him)$r +i*%

+oa!i!"N i!t$rmitt$!t

cr/i!"

Vi"oros cr/ o% scr$amN

risi!"N shri**. 8o!ti!os.

KLot$F -i*$!t cr/ ma/ H$ scor$% i,

HaH/ is i!tHat$%N as $Bi%$!c$ H/

oHBios mothN ,acia* moB$m$!t.M

%"#$i)4P#$$"%)

5$*aE$% Ysa* )att$r!:or this HaH/

T$!s$N irr$"*arN

,ast$r tha! sa*N"a""i!"N Hr$ath

ho*%i!"

99999

A%,

5$*aE$% Lo msc*ar

ri"i%it/N occasio!a*

ra!%om arm moB$m$!t

T$!s$N strai"ht armsN

ri"i% a!%


17/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" > o5 6

S$#$" o5 A%o!#l

-*$$)i!"` mi*% to !o )ai! Lo!$@9C`mi*% to mo%$rat$

)ai!

Lo!$ Pharmaco*o"ica* i!t$rB$!tio! 1ith a r$ass$ssm$!t i! *$ss tha! @? mi!t$s

_C`s$B$r )ai! Pharmaco*o"ica* i!t$rB$!tio! 1ith a r$ass$ssm$!t i! *$ss tha! @? mi!t$s



18/21


HOSPITAL


TITLE: MODERATE & DEEP SEDATION I!" D#$" : M#%c '009R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 6 o5 6


NEONATAL PAIN ASSESSMENT SCALE NIPS +#i) Sc#l"

P#i) L"("l I)$"%(")$io)

?9>` mi*% to !o )ai! Lo!$

@9C`mi*% to mo%$rat$

)ai!

Pharmaco*o"ica* i!t$rB$!tio! 1ith a r$ass$ssm$!t i! *$ss tha!

@? mi!t$s

_C`s$B$r )ai! Pharmaco*o"ica* i!t$rB$!tio! 1ith a r$ass$ssm$!t i! *$ss tha!@? mi!t$s

F#c" c#l" & )!,"%ic#l c#l":

=9@ K ,ac$ LoF>M !o!9 )harmaco*o"ica* tr$atm$!t a!% )ossiH*$ mi*% a!a*"$sic.

_`C K,ac$ LoF@M i!,orm )h/sicia! a!% )harmaco*o"ica* i!t$rB$!tio!

P#i) Sc#l" Fo% Co,#$o" P#$i")$

Sco%" 0 Pati$!ts scori!" ? ar$ i%$!ti,i$% as thos$ 1ho %o !ot haB$ )ai!. Lo

,rth$r ma!a"$m$!t.

Sco%" Pati$!ts scori!" b r$Jiri!" mi!ima* )ai! ma!a"$m$!t Ht sha** H$

r$ass$ss$% at *$ast o!c$ $B$r/ shi,t. Th$s$ )ati$!ts ma/ r$Jir$ !o!

Pharmaco*o"ica* i!t$rB$!tio!s.

Sco%" Pati$!ts scori!" bb r$Jir$ )ai! ma!a"$m$!t. Th$/ sha** H$

r$ass$ss$% si!" th$ aHoB$ "i%$*i!$s as )$r th$ Pai! &ss$ssm$!t

a!% +a!a"$m$!t Po*ic/ a!% Proc$%r$ Ii%$*i!$.

FLACC P#i) Sc#l" REPORTALE CONDITIONS

:&88 )ai! scor$ _ .

Y!r$*i$B$% )ai! or 1ors$!i!" )ai!.

&H!orma* Bita* si"!s

") $o A"/ R"#" 5o% +#i):

&ss$ss )ai! at $ach Bisit a!%


19/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" 9 o5 6

F&83 L3I- A8TAVAT4 C54 C(L-(&OAAT4 KFLACCM P#i) Sc#l"K:or 8hi*%r$! =

) to /$arsM

REPORTALE CONDITIONS

:&88 )ai! scor$ _ .

Y!r$*i$B$% )ai! or 1ors$!i!" )ai!.

&H!orma* Bita* si"!KsM

EHA7IORAL-PHYSIOLOGICAL PAIN SCALE FOR

NON-7ERAL OR PRE-7ERAL PATIENTS

Sco%" A",")$ G!i"li)"

0 Lo -i"!s o, ArritaHi*it/ or Pai! 3EhiHit$%


CATEGORIES SCORING

0 '

FACE Lo )artic*ar $E)r$ssio! or

smi*$

(ccasio!a* "rimac$ or

,ro1!N 1ith%ra1!N%isi!t$r$st$%.

:r$J$!t to

co!sta!tJiB$ri!" chi!N

8*$!ch$% a1.

LEGS Lorma* )ositio! or r$*aE$%. Y!$as/N r$st*$ssN t$!s$. 7icki!" or *$"s

%ra1! ).

ACTI7ITY /i!" Ji$t*/N !orma*

)ositio! moB$s $asi*/.

-Jirmi!"N shi,ti!" Hack

a!% ,orthN t$!s$.

&rch$%N ri"i% or

$rki!".

CRY Lo cr/N Ka1ak$ or as*$$)M +oa!s or 1him)$rs^

occasio!a* com)*ai!t

8r/i!" st$a%i*/N

scr$ams or soHsN

,r$J$!t

com)*ai!ts.

CONSOLAILITY 8o!t$!tN r$*aE$%. 5$assr$% H/ occasio!a*tochi!" h""i!" or H$i!"

ta*k$% toN %istractiH*$.

Di,,ic*t/ toco!so*$ or

com,ort


20/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" '0 o5 6

-i"!s o, ArritaHi*it/

A!t$rmitt$!t Boca*iSatio!sN so,t or Hri$, cr/ Ht ableto sck or ,$$%

A!cr$as$% actiBit/ o, $Etr$miti$sN r$st*$ssN )r)os$*$ss moB$m$!ts Ht tr!k is r$*aE$%

:ro1!i!"N ,rro1$% Hro1N $/$s o)$!

+i*%*/ i!cr$as$% to!$ o, $Etr$miti$s

A!cr$as$% arosa*N mor$ a1ak$ tha! sa* Y!$E)*ai!$% mi*% cha!"$s i! r$s)irator/ )att$r!N #5 a!% OP

-i"!s o, Pai!

o% cr/N sstai!$% att$m)ts to cr/

5$,s$s to ,$$%N $at a!%


21/21


HOSPITAL



R"(iio) No*: 0'


Di$%i2!$io) : Ho+i$#l i" P#4" ' o5 6

53:353L83F&m$rica! -oci$t/ o, &!$sth$sio*o"ists^&%Bisori$s o! "ra!ti!" )riBi*$"$s

to !o!9a!$sth$sio*o"ist s$%atio! )ractitio!$rs.(ctoH$r >?? ' >?==


ppg-gdch-anesot-03.09 moderate and deep sedation

Documents