Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Lam PY(1)
Affiliation :
(1)Department of Anaesthesia & Operating Theatre Services, North District Hospital
Introduction :
In October2023, a newly implemented workflow with the mnemonic "SEDATE ME" to enhance patient safety in LA procedures with sedation was launched in OT at NDH, in response to current circumstance of increasing service demand. Service gap in patient care was identified. "SEDATE ME" protocol stands for: • S: Safety checking by safety checklist & identify high risk group before sedation procedure • E: Equipment preparation of antidotes rescue kit and EtCO2 monitoring pre-operatively • D: Drug administration with 3-checks-5-rights and independent checking • A: AVPU assessments (Alertness, Verbal, Pain, Unresponsiveness) for sedation level intraoperatively • T: Timely documentation • E: Evaluation the effect & side-effects of drug administered to achieve the best clinical response • M: Monitoring patients’ vital signs continuously • E: Ensure safe discharge from PACU
Objectives :
(1) To establish an effective protocol that adheres to evidence-based practices (2) To enhance staff competency and knowledge on LA procedures with IV sedation by implementing comprehensive training programs (3) To enhance crisis management by improving the accessibility of emergency equipment and medications, ensuring prompt and effective response during critical situations.
Methodology :
Plan-Do-Check-Act was employed for the project design. It began by establishing a workgroup to develop a standardized workflow prioritizing patient safety, incorporating evidence-based practices. An assessment form was created for identifying high-risk patients. Approval was obtained from DOM. Comprehensive training was provided for equipping nurses with the necessary related knowledge and competency. A pilot study was implemented for 30 cases of inguinal hernia mesh repair with LA procedures with IV sedation. Tools to evaluate project effectiveness included:(1)Pre and post-tests, (2)workflow checklist, (3)evaluation surveys.
Result & Outcome :
It was successfully implemented from November to December2023. There is 98% complied with the new workflow. Pre-operative assessment identified 20% of cases as high-risk patients, enabling surgeons to adjust drug dosages accordingly. Over 80% of nurses had positive feedbacks. The availability of emergency equipment and medications ensured prompt response during critical situations. “SEDATE ME” protocol contributes to an enhanced level of patient safety in a systematic way after the trial. Not only the training program has improved nurses’ competency in the related field, but safer procedural experiences can also be provided. However, it has room for improvement as sample size was relatively small.
