Clinical update

Safe sedation practice in the emergency department

New guidance from the Royal College of Emergency Medicine on advanced clinical practitioners’ airway management skills

New guidance from the Royal College of Emergency Medicine on advanced clinical practitioners airway management skills

Essential facts

Patients in the emergency department may need to undergo painful, unpleasant or distressing diagnostic or therapeutic procedures as part of their care, necessitating sedation.

Procedural sedation (PSA) is used to help manage short and potentially painful procedures, such as wound exploration, suturing, incision and drainage of abscesses, manipulations of fractures and dislocations.

The aim is to relieve the patients anxiety and foster cooperation, while producing a state of reduced consciousness, where someone is still able to respond to verbal or physical stimulus, says the Royal College of Emergency Medicine (RCEM).

Whats new?

...

New guidance from the Royal College of Emergency Medicine on advanced clinical practitioners’ airway management skills

A masked nurse using safe sedation on a patient
Picture: iStock

Essential facts

Patients in the emergency department may need to undergo painful, unpleasant or distressing diagnostic or therapeutic procedures as part of their care, necessitating sedation.

Procedural sedation (PSA) is used to help manage short and potentially painful procedures, such as wound exploration, suturing, incision and drainage of abscesses, manipulations of fractures and dislocations.

The aim is to relieve the patient’s anxiety and foster cooperation, while producing a state of reduced consciousness, where someone is still able to respond to verbal or physical stimulus, says the Royal College of Emergency Medicine (RCEM).

What’s new?

In November 2020, the RCEM published a new position statement, Emergency Medicine Advanced Clinical Practitioners (EM-ACPs) Providing Safe Sedation in the Adult Emergency Department.

This document explains the reasoning behind the practice and how to develop and maintain it safely.

EM-ACPs are expected to provide care to patients needing PSA, says the statement, with the ability to perform this core skill safely.

This involves knowledge and competency in several key areas, such as:

  • Safe sedation practice.
  • Pharmacology.
  • Management of complications.
  • Appropriate post sedation care.

Key recommendations

The RCEM position statement recommends that EM-ACPs should have emergency airway skills up to, but not including, drug-assisted intubation. They also must:

• Have completed the advanced life support course or its equivalent.

• Have attended an approved educational programme on safe sedation.

• Comply with local guidance and policies, with respect to PSA.

• Complete a log book of all sedations performed, including adverse events and outcomes.

• Undergo a yearly workplace-based assessment on airway management skills.

The guidance recommends that local guidelines for PSA (including non-medical practitioners) should be developed, approved and implemented, which identifies competencies rather than profession.

All sedation (including that undertaken by the advanced clinical practice workforce) must be regularly audited, results presented at local governance meetings, and quality improvement action undertaken if needed.

Safe sedation training and competency sign off by consultant should be in-situ for the EM-ACP, the guidance adds, and a consultant or Tier 4 practitioner must be immediately available when EM-ACP providing sedation.

How you can help your patient

Providing safe sedation can help patients achieve the best results from a procedure. It ensures they are as comfortable as possible, reducing their anxiety and helping them to relax more easily.

Assessing whether the patient is suitable for sedation can be the most difficult aspect of the process. Practitioners need to be aware of any potential complications and how to manage them.

To build up confidence and competence, full training must be provided, with assessment.

Expert comment

Rob Fenwick, lead advanced clinical practitioner in emergency medicine, University Hospitals Birmingham NHS Foundation Trust

Rob Fenwick is lead advanced clinical practitioner in emergency medicine, University Hospitals Birmingham NHS Foundation Trust

‘This is a useful document. It’s fantastic that the Royal College of Emergency Medicine is supporting emergency medicine advanced clinical practitioners (EM-ACPs) to provide safe sedation. Having medical colleagues supporting non-medical practitioners in this is phenomenal and a big achievement in itself.

‘Safe sedation needs three members of staff –a nurse, someone to do the procedure and someone to do the sedation.

‘EM-ACPs usually carry out the procedure, but this enables them to also perform safe sedation, moving into a new and different role within the team. It’s exciting, but also the logical next step.

‘It’s also a big step towards overcoming local barriers. With national colleges supporting non-medical practitioners to perform procedural sedation (PSA), it opens the door for local solutions to be found. But it needs to be introduced carefully, with training, as it’s a skill that takes time to learn.

‘If you have EM-ACPs who are trained to perform PSA, undoubtedly patients will have better access to this as a treatment option, as historically it’s been hard to find people who can do this 24/7. It gives an extra layer of people we can rely on, and who will follow local guidance and policies and procedures to ensure patients have the best outcome.’

Find out more


Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to emergencynurse.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs