Moderate Sedation by K2N

Response to Essay on Moderate Sedation by K2N
Emergency departments see many cases coming in whereby moderate sedation is required to minimize stress in the patient as a starting point of treatment. Breathing apparatuses are not always used and this can be a concern if there is some type of obstruction, particularly if the patient does go under (Godwin et al., 2014. Mayo Clinic, 2014). Currently, the level of sedation is determined by the issues presented by the patient entering the emergency room. Registered nurses are responsible for non-invasive blood pressure (NiBP), pulse oximetry (SPO2), cardiac monitoring, along with direct observation of respiratory status, as K2N has stated (Godwin et al., 2014).
K2n points out the importance, however, of using the end-tidal carbon dioxide (ETCO2) monitor which is most likely to indicate respiratory depression, particularly if there is COPD or some other obstruction of the air paths. This is important as part of moderate sedation or higher levels and while these monitors are currently supplied throughout the Integris Southwest Medical Center, IISMC), they are not in use as mandatory applications in moderate sedation. This should be changed to be a mandatory application to ensure patient safety (Kodali, 2013). It is suggested that a program be put in place to train all medical personnel to have full knowledge and skill in utilizing this tool. This will include physicians, residents and all nursing staff (Melnyk amp. Fineout-Overholt, 2011).
As K2N points out, everyone will be brought up to the same level of education in Capnography readings and waveforms, and this will include a full listing of the training modules, including PowerPoints, which will be made available, presumably, on the center’s Intranet. K2N, however, does not present a specific initial method of disseminating the information, such as in a roundtable, for the initial overview. Center Leadership should always be included in the first output of dissemination of the information regarding the program, including the Financial Officer, who must make a financial determination of the cost in using this tool more often, and what it will cost to maintain it accordingly. Accordingly, if current staff members, who are already knowledgeable in how to use the apparatus, will be required to conduct the training, then a schedule may need to be designed to allow for such training, so no one person is teaching more than another one (Melnyk amp. Fineout-Overholt, 2011).
This plan looks to be a very promising addition to the function of the emergency department, albeit that there are some wrinkles that will need to be smoothed out before implementation. The plan, in dissemination of the information, is a bit vague, but implementation will be an important addition to the emergency department. There should also be a review after a certain number of weeks, maybe two, to determine how the program is working, relative to the success in the emergency department, and how finances are affected by the changes (Melnyk amp. Fineout-Overholt, 2011). While it may cost a bit more to use the apparatus, there appears to be recovery in not using other components, normally used in the department.
Resources
Godwin, S.A., Burton, J.H., Gerado, C.J., Hatten, B.W., Mace, S.E., Silvers, S.M., amp. Fesmire, F.M. (2014). Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department. Annual of Emergency Medicine, 63, pp. 247-258. www.acep.org/content.aspx.
Kodali, B.S. (2013). Capnography During Sedation. PowerPoint. Capnography Online. Retrieved from http://www.capnography.com/new/teaching-module-for-sedation.
Mayo Clinic. (2014). Moderate Sedation at Mayo Clinic Health System. PowerPoint. Mayo Clinic Health System Online. Retrieved from http://mayoclinichealthsystem.org/~/media/Local%20Files/Eau%20Claire/Documents/Careers/MODERATE%20SEDATION%20for%20internet.pdf.
Melnyk, B.M., amp. Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing amp. Healthcare (2nd ed.). Baltimore, MD: Wolters Kluwer Health.