SEDATION AND ANALGESIA DURING PROCEDURES
QUICK REFERENCE (MC Policy 1327)
Sedation Scale
0 = Calm, follows command
-1 = Drowsy, will arouse to verbal (Moderate “Conscious” Sedation)
-2 = Awakens to noxious stimuli only (Deep Sedation)
-3 = Unarousable to any stimuli (General Anesthesia)
Definition of Terms:
1. Minimal Sedation (Anxiolysis): Minimal sedation applies to a single medication (IV or PO) given
prior to a procedure and policy does NOT apply. Patients respond normally to verbal commands, but
ventilation and cardiovascular functions are not affected. If additional medication is given (more than a
single medication) during procedure, the policy is in effect. Requires routine monitoring of VS and
patient's response to sedation.
2. Moderate Sedation (Conscious Sedation): Minimally depressed level of consciousness. Patient is able
to maintain patent airway independently, able to respond appropriately to verbal command e.g. "open your
eyes", and to physical stimulation (-1 on Sedation Scale / Drowsy, will arouse to verbal). To administer
moderate sedation, M.D. must be "privileged" to administer Moderate Sedation. Requires Q15 minute
documentation of VS (HR, BP, RR, Sp02, Level of Sedation, Pain).
3. Deep Sedation: Drug induced depression of consciousness in which patient is NOT easily aroused (-2 on
Sedation Scale / Awakens to noxious stimuli only). Patient may have partial or complete loss of
protective reflexes & unable to maintain patent airway. Policy in effect - To administer deep sedation,
MD must be "privileged" for administration of Deep Sedation. Requires Q5 minute monitoring and
documentation of VS (HR, BP, RR, Sp02, Level of Sedation, Pain).
4. Anesthesia: General anesthesia is a drug-induced loss of consciousness with inability to maintain a
patent airway (e.g. ventilation required). Patient is NOT arousable even by painful stimulation (-3 on
Sedation Scale / Unarousable to any stimuli). General anesthesia is administered only under the care
of an anesthesia practitioner and exceeds the scope of the Sedation Policy.
Who is Excluded from the Policy?
1. Patients receiving a single dose of medication (standard out-patient dose, prior to procedure).
2. Patients undergoing Minimal Sedation/Anxiolysis (as defined above).
3. Intubated (ventilator patients) in critical care areas who will be mechanically ventilated during/after
procedure.
4. Patients having surgery or other procedures under the care of anesthesia practitioners.
RN “ESSENTRIS” Documentation: (See attached ESSENTRIS Examples)
1. On Essentris “Vitals Flowsheet”, click on Conscious Sedation; Add Row; & insert items for documentation
 Indicate Procedure, “Start Time” and “Completion Time” on Flowsheet VS graphics.
2. Record BP, HR, RR, Level of Sedation and Pain and Pre-procedural Aldrete Score as a baseline
assessment (see Conscious Sedation Drop down items).
3. During the procedure, the RN remains at BS and records VS (HR, BP, RR & Sp02), Pain and Level of
Sedation (see Sedation Scale):
 Every 15 minutes during the procedure for Moderate (Conscious) Sedation (-1 on Sedation Scale)
 Every 5 minutes during the procedure for Deep Sedation (-2 on Sedation Scale)
4. Record all medications (time, route, site, dose) as ordered BY MD for Sedation Procedure
5. Post-Procedure and during Recovery Period, record VS (BP, HR, RR and Sp02), Pain, Sedation Level, and
Post-Procedural “Aldrete Scores”:
 Every 15 minutes until patient is recovered (all physiologic variables must be stable for at least 30
minutes after last dose of medication and no airway support required).
 Record ANY adverse occurrences under “Outcomes” (See dropdown list)
Note: Physician Privileges: Sedation shall be ordered & supervised by a physician privileged for administration of sedation and analgesia. A
physician in-training or nurse practitioner administering sedation MUST be under direct supervision a “privileged” physician.
Revised 02/10 M. Keckeisen RN, MN, CCRN
Documentation of Sedation Procedure on VS Flowsheet
Indicate Start time and
Completion Time on VS
Flowsheet Graphics
Conscious Sedation – Essentris Documentation Items
Sedation score should reflect the
Intended level of sedation (-1 for
Moderate versus -2 for Deep)
Post Procedure/Recovery Documentation
Q15 Vitals until patient recovered/
return to baseline; Record any
adverse events at end of procedure
Guidelines for Anesthesiology Consultation
1.
It is appropriate that an anesthesiology consultation be considered prior to sedation if the H&P
notes one or more of the following conditions, which may require skills outside the area of
expertise of the physician (or physicians) present during the procedure:
2.
Patient has recently eaten and requires emergency procedure.
3.
Neurological disease, cardiopulmonary disease (e.g., recent MI, dyspnea) or other organ system
disease felt to present a significant hazard.
4.
Concerns related to airway management, e.g. distorted anatomy or immobilization of the head
and/or neck.
5.
Significant obesity
6.
Patient taking medications that may adversely react with moderate sedation agents, e.g. MAO
inhibitors.
7.
Previous adverse reaction to sedation or anesthesia.