Are you a nurse or midwife involved in the safe sedation of patients? Make sure you’re up to date with the new ANZCA competencies being rolled out this year.

The Australian and New Zealand College of Anaesthetists (ANZCA), in collaboration with nursing, medical and dental practitioner groups, have developed an agreed set of safe procedural sedation competencies. The result of this collaboration has been an agreed set of 11 core competencies which ANZCA will incorporate into its profession document Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures later this year.

The 11 core competencies are:

1. Conduct a thorough pre-sedation assessment of a patient, identifying clinical features, pre-existing conditions and medications that predispose patients to adverse sedation related events.

2. Stratify patients according to risk, and refer those patients at high risk of adverse sedation-related events to a specialist anaesthetist.

3. Determine the requirements for anxiolysis and/or analgesia before the procedure, taking into account the complexity and likely discomfort of the procedure for the patient.

4. Clearly communicate the risks of procedural sedation to the patient (in addition to risks associated with the procedure itself), to obtain valid informed consent and address patient expectations.

5. Prepare for an episode of procedural sedation ensuring that:

• equipment for monitoring and for emergencies is available and functional in both the procedure and recovery areas;
• at least the minimum recommended staff are present during the procedure and in the recovery area, all of whom have current basic life support skills;
• at least one clinical staff member present is current in advanced life support skills and can stop what they are doing immediately in the event of an emergency;
• drugs for sedation and for emergencies are immediately available;
• all team members have a shared understanding of their responsibilities and the patient care plan, including emergency protocols.

6. Administer sedation/analgesic drugs, titrating them to effect, taking into consideration the differing onset times, doses, peak effects and duration, to ensure completion of the entire procedure.
7. Continually monitor patient comfort and record regular observations, according to local guidelines.

8. Recognise the deteriorating patient, initiate management or rescue and call for help if required.

9. Ensure the patient is safe to be transferred to a recovery area and a formal handover of care, along with documentation of the sedation and plan for ongoing care, is completed.

10. Ensure continual observation and monitoring of the patient in the recovery area until the patient meets pre-defined criteria for discharge.

11. Ensure written discharge information is provided for all patients before they leave the facility with their carer, including instructions for steps to take in the event of an emergency.

The complete document can be accessed on the ANZCA website. The full document provides further guidance for competencies 1, 6, 7 and 10 and provides definitions to key terms.

The safe procedural sedation competencies are designed to be used by all practitioners providing patient sedation for diagnostic and/or interventional procedures. They are intended to be incorporated into the training and assessment of trainees and continuing professional development programs. These competencies are suitable for a broad range of professional groups and represent a minimum standard of competency.