Sedation / Analgesia Checklist

Notify SWAT as soon as you know your patient needs sedation/analgesia.

To request the SWAT team:

1. Dial 6-6032 (Survival Flight Dispatch Office) or page 8000.
   Information needed: Patient name, patient unit, procedure being done, time of procedure if known, pager or phone number where physician can be reached.
   
2. We will return your call ASAP - please remember we may be in transport.

Inclusion criteria for sedation:

Adult: The only inclusion criteria to consider for adult patients for application of the guidelines is the intended level of sedation. Thus, these guidelines apply to any patient given any sedative/analgesic for a procedure where it is the intent, expectation, or it can be reasonably anticipated that a sedation score greater than level 1 will result. It is generally assumed that when an anxiolytic and opiod are given in combination, that the intent is a level of sedation deeper than level 1.

Pediatric: The guidelines are applied to all pediatric patients, regardless of the intended level of sedation. Pediatric patients are defined as less than 16 years old. It is recognized that adult guidelines may be more applicable to patients between the ages of 12-16. This is left to the discretion of the practitioner.

Exclusion criteria for sedation

1. All patients who receive sedation via any route that is specifically administered for the management of acute or chronic pain, anxiety, or insomnia which is not being administered to facilitate a diagnostic, therapeutic, or minor surgical procedure.
2. Patients who are recieving peripheral nerve blocks, local or topical anesthesia, and no other sedative or analgesic agent administered by any route.
3. Intubated and mechanically ventilated patients in the intensive care unit who require sedation for any reason shall be monitored according to intensive care unit policy.
   

What we need from you:

1. Written sedation order
   Pt. has to be NPO for sedation per anesthesia guidelines:
   1. Adult:
      1. Clear liquids 2 -3hours
      2. Solids/non clear liquids-6-8 hours
      Pediatric:
      1. Clear liquids 2 hours Breast milk 4 hours
      2. Infant formula/non-human milk/light meal-6 hours
      Holden:
      1. Clear Liquids-2 hours Breast milk 4hours
      2. Formula/solids 6hours
      Exception:
      1. J-tube feedings
   2. Emergencies only: Bicitra 30cc (adult dose), or Bicitra 0.5/kg (pediatric dose) can be given 45 minutes prior to procedure for patients who have not been NPO.
      
   An appropriately credentialed member of the Medical Staff is at all times, responsible for all aspects of Sedation Analgesia. The staff or designee must remain in the area of the sedation/procedure area. If this individual needs to leave the area it is their responsibility to identify qualified staff who will remain in the immediate sedation/procedure area and be available to rescue the patient from a deeper than intended level of sedation during the procedure and recovery period.
   Please have the physician fill out the pre-sedation assessment and history portion of the Sedation/Analgesia Record and sign his or her name in the appropriate spot.
   Either the patient or designated person need to be available to sign consent (for procedure and sedation both), if physician can get consent ahead of time this is most helpful.
   
2. Please see link to the Sedation/Analgesia policy for further clarification or questions.

What we need at the bedside:

1. Patent IV
   Suction at the bedside including canister tubing and yaunkeur (attached and working).
   Oxygen flow meter with nasal canula
   SWAT will obtain the drugs for the procedure.
   SWAT will stay with the patient until they are back to their baseline vital signs and LOC.
   
2. Patients must be able to maintain a patent airway independently, manage oral secretions, demonstrate the ability to swallow or an active gag reflex and have the ability to move and ambulate safely or consistent with pre-procedure status..

1. Current SWAT Team hours of operation: Monday - Friday 0700 - 2300 & Saturday 0700 - 1900

2.  To request SWAT Team assistance for patient transport or bedside sedation, please notify the Survival Flight Dispatch office at 6-6032. Provide the following information: patient name, unit, procedure, call back number, and time, if known.

3. Notify Survival Flight Dispatch as soon as you are aware of a procedure that you need assistance with. Many times we are able to coordinate times with the procedural areas, allowing us to complete the transport.

4. Our goal is to provide assistance to as many units as possible. Unfortunately we cannot always predict our availability for each procedure. We will try to notify the respective unit 30 minutes prior to the procedure as to whether or not we will be able to provide assistance. Please remember that we are often with critically ill patients and may not be able to return pages promptly.