VHA National Center for Patient Safety

Moderate Sedation Toolkit for Non-Anesthesiologists

To assist VA facilities in assuring that the practice of moderate sedation health care worker holding chart is reliable and safe, the VA National Center for Patient Safety (NCPS) has developed a Moderate Sedation Toolkit for Non-Anesthesiologists, based on work done at the Durham VAMC Patient Safety Center of Inquiry. VA professionals can access the toolkit on the internal NCPS SharePoint site when connected to the VA network.

The toolkit is composed of nine components:

1. Facilitator's Guide this introductory guide describes the moderate sedation toolkit components and provides guidelines for the sedation training facilitator including answers to frequently asked questions..
2. Learner Objectives these 18 objectives describe the knowledge, skills and behaviors that should be demonstrated by individuals who administer moderate sedation.
3. Curriculum Guide this document provides detailed information about moderate sedation practice. Topics include:
   • Introduction - general principles of moderate sedation
   • Pharmacology of commonly used medications
   • Relevant anatomy and physiology
   • Principles of pre-procedural patient assessment and education
   • Monitoring guidelines and techniques
   • Intra-Procedure Guideline - required safety equipment and common complication recognition and treatment
   • Special situations and high-risk patients
4. Pre-Procedure Evaluation Template this template identifies key features of patient evaluation that should be performed prior to beginning a procedure that requires moderate sedation. Facilities may use this as a guide for creating CPRS templates.
5. Moderate Sedation Study Aid this colorful graphic summary includes key elements of moderate sedation practice, including many of the topics from the curriculum guide. This 8.5- by 11-inch front and back reference guide may be posted for practitioners in all sites where moderate sedation is administered.
6. Moderate Sedation Cognitive Aid modeled after the NCPS Cognitive Aid for Anesthesiology, this colorful 8.5- by 11-inch front and back reference guide provides bulleted guidelines for managing common complications of moderate sedation (hypotension, hypertension, bradycardia, tachycardia, hypoxemia and agitation/difficult to sedate). Each complication is addressed in three parts: initial response; follow-up response; and things to consider. It is intended to be available to practitioners in all sites where moderate sedation is administered.
7. Call for Help Card this template identifies key resources for assistance. Facilities must customize this card for local use. The local version should be posted and CLEARLY VISIBLE in all sites where moderate sedation is administered.
8. High-Fidelity Simulation Cases four cases are available for use in facilities that have the capability to conduct simulation training using a high-fidelity medical simulator. The cases demonstrate the common and important problems encountered during sedation practice.
   • Case 1: Orientation to Simulator and Training Sessions
   • Case 2: Upper Airway Obstruction
   • Case 3: A Difficult to Sedate Patient
   • Case 4: Medically Compromised Patient
9. Table Top Simulation Cases four cases are available for use in all facilities, specifically those that do not have the capability to conduct simulation training using a high-fidelity medical simulator. These cases cover the same material available in the high-fidelity sedation simulation cases described above.

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