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Moderate Sedation


What should be included in the plan for a mock code in the operating room?

Answer:

Cardiac Include a list of responsibilities for each team member (eg, RN circulator, scrub person, surgeon, RN first assistant, resident, OR charge nurse) in the plan for a mock code. In addition, include instruction on proper documentation and training for specialized equipment. Education and training of staff members is critical to implementing any practice. Furthermore, quality improvement activities can identify which parts of the training are adequate or deficient. During the mock code be certain to include all members of the perioperative team including anaesthesia and the medical doctors.

Resources

  • Recommended practices for managing the patient receiving moderate sedation/analgesia. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:415-424.
  • Seifert P. Thinking critically. AORN J.2010;91(2):197-199.

Updated January 28, 2013 

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How often should we perform mock codes in the operating room?

Answer:

The frequency of the mock code drill is determined by the needs of your individual facility. Consider in your plan that cardiac arrest in the OR is not a common occurrence, or in terms of competency, it is considered a high-risk/low volume event. Collaborate with perioperative educators and practitioners to design a mock code drill and schedule that facilitates best practices.

Resources

  • Recommended practices for managing the patient receiving moderate sedation/analgesia. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:415-424.
  • Seifert P. Thinking critically. AORN J.2010;91(2):197-199.

Updated January 28, 2013 

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Who should lead a mock code in the operating room?

Answer:

A key component of the mock code drill is to identify a code director, such as the anesthesia care provider, or in the instance of a local or moderate sedation procedure, the surgeon. The code director should be a person that will potentially lead a cardiac arrest event in the operating room. Collaborate with anesthesia care providers and surgeons to determine a suitable candidate for the code director role in the mock code drills.

Resources

  • Recommended practices for managing the patient receiving moderate sedation/analgesia. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:415-424.
  • Seifert P. Thinking critically. AORN J.2010;91(2):197-199.
  • Woolson P. Responding to cardiac arrest. OR Manager. May/June 2004:31-36.

Updated January 28, 2013 

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What are the responsibilities for the circulator and scrub during a mock code in the operating room?

Answer:

The following are examples of responsibilities for the RN circulator and scrub person.

RN circulator:

  • Activates the code emergency system.
  • Retrieves the code cart.
  • Assists in re-positioning the patient to facilitate cardiopulmonary resuscitation (CPR).
  • Notifies chain of command personnel and requests assistance as needed.
  • Controls traffic.
  • Attends to the sponge, sharp, and instrument counts, especially if the wound closure was in progress.
  • Assists in maintaining the sterile field secondary to resuscitative efforts.
  • Delegates duties to other personnel.
  • Documents activities.
  • Performs compressions as directed.

Scrub person:

  • Maintains sterility of self and field.
  • Assists in patient re-positioning.
  • Attends to needs of surgeon and assistants.

Resources

  • Recommended practices for managing the patient receiving moderate sedation/analgesia. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:415-424.
  • Seifert P. Thinking critically. AORN J.2010;91(2):197-199.
  • Woolson P. Responding to cardiac arrest. OR Manager. May/June 2004:31-36.

Updated January 28, 2013 

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Does the patient’s exhaled carbon dioxide (CO2) need to be monitored during all sedation procedures, including those monitored by perioperative nurses?

Answer:

Nurses should monitor exhaled CO2 (ie, end-tidal CO2 [EtCO2]) continuously. Along with monitoring exhaled CO2 during the administration of moderate sedation, nurses should observe the adequacy of the patient’s ventilation during the procedure.

Resource

  • Denholm, BG. Patient monitoring during moderate sedation administration. [Clinical Issues]. AORN Journal. 2012;95(4):541-543.

Updated January 28, 2013 

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