J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 54(12); 2011 > Article
Kweon: Update of sedation in view of Joint Commission International standards

Abstract

Although the practice of sedation has markedly increased and expanded beyond the operating room with the development of new diagnostic and minimally invasive surgical procedures, there is no guideline for hospitals to set up a sedation policy in Korea. The Joint Commission International (JCI), which is a division of Joint Commission of United States, has urged Korean hospitals to develop guidelines for sedation. Because JCI defines the sedation standards as a minimum, there is much for Korean medical association and physicians in charge of sedation to do in order to improve the safety of sedated patients and set up an economical and efficient sedation system. There are three main requirements to meet JCI standards. Aqualified individual responsible for sedation should complete a formal training program supervised by an anesthesiologist or experienced practitioner, and adequate facilities and monitoring systems must be available to safely care for patients throughout sedation. Secondly, a documentation process around sedation, including informed consent, pre-operative assessment, the parameters observed during sedation, and discharge criteria, should be organized according to the sedation policy, which in turn should be determined by an institutional sedation committee. Lastly, JCI requires continuous quality improvement activity, which can improve the efficiency of the sedation process and the safety of sedation care. Multi-departmental joint discussion may be necessary to advance the practice of sedation and avoid conflicts among departments. This review aims to highlight the starting points of adiscussionon local standards for sedation.

References

1. Statement on granting privileges for administration of moderate sedation to practitioners who are not anesthesia professionals [Internet] 2006;cited 2011 Nov 14. Park Ridge (IL): American Society of Anesthesiologist. Available from: http://www.asahq.org/For-Members/Clinical-Information/~/media/For%2520Members/documents/Standards%2520Guidelines%2520Stmts/Granting%2520Privileges%2520for%2520Administration%2520of%2520Moderate%2520Sedation%2520to%2520Practitioners.ashx

2. Advisory on granting privileges for deep sedation to non-anesthesiologist sedation practitioners [Internet] 2010;cited 2011 Nov 14. Park Ridge (IL): American Society of Anesthesiologist. Available from: http://www.asahq.org/For-Healthcare-Professionals/~/media/For%2520Members/documents/Standards%2520Guidelines%2520Stmts/Advisory_Non-anesthesiologist_Privileging.ashx

3. Aisenberg J, Cohen LB, Piorkowski JD Jr. Propofol use under the direction of trained gastroenterologists: an analysis of the medicolegal implications. Am J Gastroenterol 2007;102:707-713.

4. Wehrmann T, Triantafyllou K. Propofol sedation in gastrointestinal endoscopy: a gastroenterologist's perspective. Digestion 2010;82:106-109.

5. Vargo JJ, Cohen LB, Rex DK, Kwo PY. Position statement: nonanesthesiologist administration of propofol for GI endoscopy. Hepatology 2009;50:1683-1689.

6. Weaver JM. The great debate on nurse-administered propofol sedation (NAPS): where should we stand? Anesth Prog 2006;53:31-33.

7. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004-1017.

8. Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children. Curr Opin Anaesthesiol 2010;23:513-517.

9. Neuhauser C, Wagner B, Heckmann M, Weigand MA, Zimmer KP. Analgesia and sedation for painful interventions in children and adolescents. Dtsch Arztebl Int 2010;107:241-247. I-II. I.

10. Godambe SA, Elliot V, Matheny D, Pershad J. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics 2003;112(1 Pt 1):116-123.

11. Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, Kareken D. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc 2002;55:815-825.

12. Heuss LT, Inauen W. The dawning of a new sedative: propofol in gastrointestinal endoscopy. Digestion 2004;69:20-26.

13. Ulmer BJ, Hansen JJ, Overley CA, Symms MR, Chadalawada V, Liangpunsakul S, Strahl E, Mendel AM, Rex DK. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol 2003;1:425-432.

14. Jalowiecki P, Rudner R, Gonciarz M, Kawecki P, Petelenz M, Dziurdzik P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology 2005;103:269-273.

15. Moerman AT, Struys MM, Vereecke HE, Herregods LL, De Vos MM, Mortier EP. Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration. J Clin Anesth 2004;16:237-243.

16. Fanti L, Agostoni M, Casati A, Guslandi M, Giollo P, Torri G, Testoni PA. Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP. Gastrointest Endosc 2004;60:361-366.

17. Roseveare C, Seavell C, Patel P, Criswell J, Kimble J, Jones C, Shepherd H. Patient-controlled sedation and analgesia, using propofol and alfentanil, during colonoscopy: a prospective randomized controlled trial. Endoscopy 1998;30:768-773.

18. Pambianco DJ, Whitten CJ, Moerman A, Struys MM, Martin JF. An assessment of computer-assisted personalized sedation: a sedation delivery system to administer propofol for gastrointestinal endoscopy. Gastrointest Endosc 2008;68:542-547.

TOOLS
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 3 Crossref
  • 3 Scopus
  • 1,158 View
  • 4 Download
Related articles in
J Korean Med Assoc

The significance of Joint Commission International accreditation2012 January;55(1)



ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next