Safety of endoscopist directed nurse administered propofol sedation for endoscopic procedures in a regional hospital
Utilisation of nurse administered, endoscopist directed propofol sedation is not widespread in Australia, despite extensive literature demonstrating its safety and effectiveness. At CairnsHospital, this has been carried out in routine practice since year 2000.
In 2001 a prospective study performed at CairnsHospital demonstrated propofol sedation safely delivered to 750 patients, with excellent patient and endoscopist satisfaction and this was presented as poster at AGW 2003
Materials and methods
Our model of sedation involves the endoscopist administering an initial dose of midazolam and propofol, and the nurse delivering additional doses of propofol as required. There is verbal confirmation between the nurses and endoscopist of drug and dose use.
All patients are monitored with blood pressure, oxygen saturation level, ECG and some are monitored with carbon dioxide level. Maximum 5 minutely observations are recorded into the computer system. The sedation nurses’ sole responsibility is to monitor the patient. A second nurse in the procedure room assists the endoscopist with procedural tasks.
We have performed 29,052 gastrointestinal endoscopy procedures between years 2000 and 2012. Our endoscopists include Staff Gastroenterologists, Staff Physicians and Staff Surgeons. Endoscopists new to the unit receive a short period of supervised training with sedation. In recent years, nursing and medical staff attend a simulation centre periodically to upgrade skills in resuscitation training.
Results
There have been no deaths related to Endoscopic sedation since 2000.
Since computerised records have been available from early 2011, there have been two MET calls in 5507 cases with good patient outcomes.
Our experience shows that Propofol can safely be administered by a nurse, supervised by an endoscopist in a regional hospital setting.
Our success relieson patient selection pre-procedure, endoscopist experience with sedation administration and patient driven sedation approach.
We are currently undertakinga prospective study reviewing the safety of propofol sedation in our ongoing cohort of patients.