7 - Nursing Considerations in Emergency Department Procedural Sedation and Analgesia

Summary

SCOPE OF THE PROBLEM

Procedural sedation and analgesia (PSA) is a standard component of emergency medicine practice. Emergency nurses are frequently called upon to assist in the assessment of and provision of care to this patient population. Although the administration of PSA medications by the registered nurse is regulated by institutional policy and state law, compliance with regulatory requirements and professional practice standards is also essential to ensure patient safety and quality care.

Both the Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) support the delivery of medications used for PSA by credentialed emergency nurses who are working under the direct supervision of an emergency physician. These professional organizations state that PSA agents potentially administered by the emergency nurse include, but are not limited to, etomidate, propofol, ketamine, fentanyl, and midazolam.

In addition to ENA and ACEP, several other professional organizations have developed clinical policies and guidelines surrounding emergency department (ED) PSA. Important aspects of these guidelines recommend formal institutional-based programs of education and credentialing for nurses who administer PSA, programs to evaluate and document competency, continuing education, staffing adequate to ensure that nurses caring for PSA patients have no other responsibilities that might interfere with the care of the PSA patient, and guidelines and protocols for aspects of PSA, including drug administration, monitoring, discharge criteria, and complication management.