Sedation

Quality statement 5

Before colonoscopy, a patient is assessed by an appropriately trained clinician to identify any increased risk, including cardiovascular, respiratory or airway compromise. The sedation is planned accordingly. The risks and benefits of sedation are discussed with the patient. Sedation is administered and the patient is monitored throughout the colonoscopy and recovery period in accordance with Australian and New Zealand College of Anaesthetists guidelines.

Purpose

To ensure the safe and appropriate sedation of patients undergoing colonoscopy.

For consumers

  • During your colonoscopy you will be given medicines to minimise your pain or discomfort (sedation). Before the colonoscopy, a doctor or nurse will check whether there are any particular risks for you when you are having the sedation. They will ask about your health, other medical conditions, medicines and previous experiences with sedation or anaesthesia. This is to make sure that you are given sedation safely. They will also talk with you about the medicines they will use during your sedation, their risks and benefits, and what you can expect to be aware of during the colonoscopy and as you recover.

  • Discuss any concerns or preferences with your doctor. Your sedation will be given according to current professional recommendations, guidelines and taking into account your risks.  Your sedation may sometimes be given by a specialist anaesthetist but this is not always required.

For clinicians

Ensure that the patient’s suitability for sedation and any increased risks such as cardiovascular, respiratory or airway compromise are assessed in advance of the colonoscopy by a clinician who is appropriately trained to make such an assessment. Ensure that the facility is appropriate for the patient taking into account their clinical requirements and co-morbidities, as described in Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines for the Perioperative Care of Patients Selected for Day Stay Procedures (2018). If an increased risk is identified, an anaesthetist, or other trained and credentialed medical practitioner within his/her scope of practice, should assess the patient and be present during the colonoscopy to care for the patient. The sedationist should discuss the risks and benefits with the patient and obtain their informed decision and consent. Ensure that the patient understands that their awareness of the colonoscopy will depend upon the depth of sedation, and that this in turn depends on the scope of practice of the clinician providing the sedation.

Sedation must be administered by a credentialed practitioner working within their scope of practice. Provide sedation as described in current ANZCA guidelines such as the Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures (2014), with respect to:

  • The number of staff present during the sedation and their level of training, competence and scope of clinical practice

  • Facilities, equipment and medicines

  • Administration of sedation

  • Monitoring of patients during the colonoscopy and in the recovery room.

For health service organisations

Sedation should be provided in accordance with current Australian and New Zealand College of Anaesthetists (ANZCA) recommendations such as the Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures (2014) and Guidelines for the Perioperative Care of Patients Selected for Day Stay Procedures (2018). Ensure that systems are in place, and services adequately resourced, to implement the ANZCA guidelines.

Policies should ensure that pre-sedation assessment is carried out by appropriately trained clinicians, in order to identify patients who are not suitable for intravenous sedation in the absence of an anaesthetist, and to plan for sedation accordingly. Ensure that clinicians who administer sedation or anaesthesia for colonoscopy are credentialed by the health service organisation and operating within their defined scope of clinical practice and that they maintain their skills by participating in ongoing professional development and review of performance. Implement and ensure compliance with policies and procedures for the safe supervision of trainees, where relevant to the facility.

For consumers

  • During your colonoscopy you will be given medicines to minimise your pain or discomfort (sedation). Before the colonoscopy, a doctor or nurse will check whether there are any particular risks for you when you are having the sedation. They will ask about your health, other medical conditions, medicines and previous experiences with sedation or anaesthesia. This is to make sure that you are given sedation safely. They will also talk with you about the medicines they will use during your sedation, their risks and benefits, and what you can expect to be aware of during the colonoscopy and as you recover.

  • Discuss any concerns or preferences with your doctor. Your sedation will be given according to current professional recommendations, guidelines and taking into account your risks.  Your sedation may sometimes be given by a specialist anaesthetist but this is not always required.

For clinicians

Ensure that the patient’s suitability for sedation and any increased risks such as cardiovascular, respiratory or airway compromise are assessed in advance of the colonoscopy by a clinician who is appropriately trained to make such an assessment. Ensure that the facility is appropriate for the patient taking into account their clinical requirements and co-morbidities, as described in Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines for the Perioperative Care of Patients Selected for Day Stay Procedures (2018). If an increased risk is identified, an anaesthetist, or other trained and credentialed medical practitioner within his/her scope of practice, should assess the patient and be present during the colonoscopy to care for the patient. The sedationist should discuss the risks and benefits with the patient and obtain their informed decision and consent. Ensure that the patient understands that their awareness of the colonoscopy will depend upon the depth of sedation, and that this in turn depends on the scope of practice of the clinician providing the sedation.

Sedation must be administered by a credentialed practitioner working within their scope of practice. Provide sedation as described in current ANZCA guidelines such as the Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures (2014), with respect to:

  • The number of staff present during the sedation and their level of training, competence and scope of clinical practice

  • Facilities, equipment and medicines

  • Administration of sedation

  • Monitoring of patients during the colonoscopy and in the recovery room.

For health service organisations

Sedation should be provided in accordance with current Australian and New Zealand College of Anaesthetists (ANZCA) recommendations such as the Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures (2014) and Guidelines for the Perioperative Care of Patients Selected for Day Stay Procedures (2018). Ensure that systems are in place, and services adequately resourced, to implement the ANZCA guidelines.

Policies should ensure that pre-sedation assessment is carried out by appropriately trained clinicians, in order to identify patients who are not suitable for intravenous sedation in the absence of an anaesthetist, and to plan for sedation accordingly. Ensure that clinicians who administer sedation or anaesthesia for colonoscopy are credentialed by the health service organisation and operating within their defined scope of clinical practice and that they maintain their skills by participating in ongoing professional development and review of performance. Implement and ensure compliance with policies and procedures for the safe supervision of trainees, where relevant to the facility.

Read Quality Statement 6 - Clinicians