VCOM Louisiana Research Day Program Book 2024

Education, Simulation and Best Practices

Zachary Schroeder, OMS-III; James Colquitt, PhD VCOM-Louisiana 65 PROCEDURAL SEDATION: A SKILLS CHECKLIST

Background: The purpose of this study is to consolidate procedural sedation techniques used in the clinic to form a checklist that can be used for a certification/check off for medical students and residents in a simulated patient setting. Current literature does not demonstrate a standardized method for procedural sedation or a certification process for it to be performed. This implies this procedure is performed regularly in the clinic by hospital staff that do not have an official check off or certification. In addressing this the hope is to reduce adverse events that occur during procedural sedation. A 2016 study performed a systematic review and meta-analysis on procedural sedation in the emergency department and found that the most common adverse event was hypoxia at 40.2 incidences per 1,000 sedations, followed by vomiting at 16.2 per 1,000 sedations, and hypotension at 15.2 per 1,000 sedations. Objective: To consolidate methods used for procedural sedation in the clinic, creating a step-by-step checklist that could be used for an efficient standardized certification/check off process in a simulated patient setting for medical students and residents. This is aimed at medical students and residents who perform this procedure before becoming fully licensed attending physicians.

Methods: A Delphi survey technique was used to gain a consensus on the steps to be taken when performing procedural sedation. This consisted of two rounds of surveys, with consolidation of the steps in between each round. The surveys used a prompt describing a patient scenario requiring procedural sedation. Physicians were recruited as subject matter experts that practice in the field of emergency medicine. These physicians were recruited from multiple states to decrease any potential regional bias. After the first survey, the second survey asked the subject matter experts to either edit, delete, move, or keep a step and a consensus was reached after two rounds of surveys. Results: We were able to create a skills checklist for performing a procedural sedation for a shoulder reduction. The Delphi technique obtained the data that we used to form this list. Conclusions: While physicians may approach procedural sedation in a slightly different manner, the same general outline for the procedure appears to be consistent. Details such as which pharmacologic sedative is used depends on patient factors determined by the physician at the time of the procedure. This checklist can be refined using different research methods as described later, and can be built

on in the future for the benefit of patients and physicians.

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