Chronic opiate users. Patients who have failed with moderate sedation in the past due to discomfort. Hypersensitivity to vomiting and nausea. History of sexual abuse. Selection of patients with irritable bowel syndrome, fibromyalgia, or previous diverticulitis. Patients with cognitive disabilities (eg, dementia). Paediatric patients.
| Anaesthesiologist on hand/readily available. Patient preference. Lengthy/complex procedure (eg, endoscopic mucosal resection). Skill level of endoscopist. Patient is alone.
|
How do we enhance patient experience under moderate sedation? |
Prior to the procedure |
Provide a friendly, clean environment for the patient. Educate the patient regardless of the sedation they will receive (standardised learning materials). Information about what to expect before, during, and after procedure. Start educating the patient as early as possible. Train all staff in proper education protocols.
Prepare the patient for possibility of pain/discomfort. Communicate and listen to the patient. Continual education/improvement for medical staff. Skill-enhancing courses for endoscopists and nurses. Ensure patients have a safe way home.
|
During the procedure |
Ensure the patient is comfortable (temperature of the room, choice in music, etc). ‘Time out’ before, during, and after the procedure where patient information (including relevant comorbidities and allergies), indications for the procedure, equipment required, findings, etc are reviewed. Use of anxiolytics to minimise recall of pain, when necessary. Communicate with the patient during the procedure (warn about any discomfort they might feel). Allow family member in the room with certain patients (eg, patients who are hearing impaired). Skilled intravenous (IV) placement. Patient-controlled sedation. Titration of sedation dosage. Start the patient lightly sedated and increase sedation, if necessary. Use of abdominal pressure and variation in patient positioning. Use carbon dioxide instead of air. Use of a scope guide.
|
After the procedure |
Confirm that patients have a safe way home. Provide next-day call or follow-up appointment. Provide contact information for patients to contact with questions or concerns. Patient rating cards provided to endoscopist (the patient rates comfort level during the procedure). Use patient feedback to improve.
|