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Running head: CLINICAL PRACTIVE GUIDELINES 1

Procedural Sedation: Clinical Practice Guidelines

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Institution

CLINICAL PRACTICE GUIDELINES 2

Procedural Sedation: Clinical Practice Guidelines

Literature Review and History

Procedural sedation is a technique employed in the administration of sedatives or in other

instances dissociative agents with the use of analgesics and in some cases without them. The aim

is to induce a state through which the patient can be able to tolerate unpleasant medical

procedures. Such maintenance is done while the cardiorespiratory function is still intact (Jones &

Heaton, 2017). Children are usually in the emergency department with painful conditions in need

of diagnostics and therapeutic measures that can be regarded as unpleasant to certain extent. The

desired effect is achieved in such settings when procedural sedation is used to manage the pain

felt by the child. The pain is managed together with anxiety. The possible adverse reactions have

to be considered along with the side effects of the medications or a combination of several

medicines. Therefore, the emergency medicine provider has to find comfort in the practice.

Emergency physicians face the challenge of using sedative agents while simultaneously applying

and honing various procedural skills in sedation with safety applications and efficacy for the

pediatric in the emergency department (Jones & Heaton, 2017).

Driving clinical practice along the lines of evidence-based medicine instead of alternative

facts demands that CPGs be composed summary recommendations that capture recent quality

and scientific evidence on a medical issue. CPG is based on a systematic review conducted to

determine presence of a condition (Jones & Heaton, 2017). The process focuses on the strengths

of such evidences by which clinical decision-making is based (Weisz, et al., 2007). The

guidelines have recommendations based on then evidences and value judgments regarding the

benefits and harms of the available options that address the management of a patient. CPG gives

CLINICAL PRACTICE GUIDELINES 3

options ranging from diagnosis, examination and intervention. Sedation procedures have become

essential in the performance of procedures on children in pediatric care.

The Institute of medicine defined clinical practice guidelines as systematically developed

guides meant to help doctors and patients arrive at a particular decision in a particular situation.

However, this view has been revised by evidence-based medical care (An, et al., 2016). The

review has led to the definition as statements assessed based on their benefits and harmful

implications, treatment methodologies and the basis of a system through literature including the

optimization methods of care through recommendations (Burbano-Paredes et al., 2017). Within a

period of 30 years, procedural sedation has evolved into a practice that requires peculiar skills

with the growth in indications and settings for practice. The operating room has various

disadvantages because of the logistic and economic disadvantages. The procedures that had been

confined to the operating room but have gone to the emergency department.

Purpose and objective of the CPG

The target population includes infants, children and adolescents still recognized as

patients under pediatric care. The sedation of children is inherently challenging; the challenges

are different from what the adults receive. Procedural sedation is done with the purpose of

ensuring that the performance of a procedure takes place in a safe environment. It recognizes the

ability of a child to recognize his/her own behavior and cooperate with different procedures

based on age and status of development. Children with an age below 6 years and those with

issues of delays in their developmental journey may need to be deeply sedated so that their

CLINICAL PRACTICE GUIDELINES 4

behaviors may be controlled compared to children who are older and more cooperative. The

purpose of effective sedation includes: Minimization of discomfort and painful experiences;

control of anxiety while reducing cases of psychological trauma and minimization of amnesia;

control of the way a patient behaves during the procedure while promoting its safe completion;

return the patient’s state to a point where discharge from care is safe.

The Informed Advocate

Parents are charged with the responsibility of becoming advocates of their children by

understanding the legal rights of the family. This is through acquainting themselves with the

provisions of relevant regulations and procedures of what is stated in their rights as legal

custodians of their families. Apart from the legal framework, the parent needs to know

something about the disability of the child so that he or she can better help in addressing it.

Improved Outcomes

One benefit is that outcomes for patients improve. With early interventions, detections can be

made earlier to prevent any further escalation of conditions facing people who have disabilities

(Koegel, Koegel, Ashbaugh, & Bradshaw, 2013). The prospects are bound to change because the

methods of addressing the situation become improved so that the issue can be tackled more

effectively.

Prevention of Secondary Symptoms

One instance of disability is Autism Spectrum Disorders. There are secondary symptoms that

accompany the primary symptoms. Such symptoms include aggression, tantrums and self-injury

(Koegel, Koegel, Ashbaugh, & Bradshaw, 2013). When the primary symptoms are addressed,

CLINICAL PRACTICE GUIDELINES 5

these secondary symptoms are dealt with more effectively and prevented from occurring. Failure

to effectively deal with such symptoms exposes the individual in question to more symptoms

which have the potential of having devastating effects to individuals.

Fiscal Savings

With early interventions, there are fiscal savings are made in the process. This saving is done

when parents are recruited as active interventionists during the process which habilitation is done

(Koegel, Koegel, Ashbaugh, & Bradshaw, 2013). The process is made to occur at an earlier time

to implement an intervention which costs much less.

Contacting Support Groups

Support groups are there to offer the much needed help to people who have special needs.

They offer help socially and emotionally. The parents can help by establishing contact with such

groups on behalf of their children who have certain forms of disabilities.

Getting Additional Help

Additional help comes from various sources such as the larger family, relatives or

friends. These may be of help along with guidance from organizations that deal with children

with disabilities. The help provided by the organizations may help in navigating through various

places to acquire the much needed stamina to help the child through his or her condition.

Participating in a Child’s Services

This means that the parent has to collaborate with the people who aim at providing the

much needed help in raising the child with a disability. Participation may involve either asking

for or providing regular reports on the progress of the child.

CLINICAL PRACTICE GUIDELINES 6

In light of these realities, the healthcare systems are making a shift from acute care to

wellness, prevention and accountability. This shift aims at helping stop diseases before they start

and to give people a chance to be healthy and fit. The National Prevention Council Health

Department in the Patient Protection and Affordable Care Act is planning to shift the nation’s

healthcare system from a focus on sickness and diseases to a system focused on prevention and

wellness (Community Catalyst, 2010).This change is driven towards helping patients manage

their health and care by providing them with the information, skills, capabilities and the support

they need to make smarter choices. These changes are in an effort to improve people’s health and

cultivate good health cultures which will result in better and healthy lifestyles. The healthier the

people are the more productive and innovative they will be.

Employees who are free from such issues dealing with mental and physical conditions

that lead to sickness take fewer sick days off; they are more productive and assist in

strengthening the economy. It is for this among many other reasons that many businesses are

making an effort to improve their approach towards their employees’ health by offering them

wellness programs. With the enactment of the Affordable Care Act, wellness programs will

become part of a national public health strategy to help deal with the increase in chronic

diseases. Chronic diseases have become a major concern for employers because of the escalating

healthcare cost. The number of people with chronic conditions has increased with increase in the

age of people. These include conditions such as depression, anxiety and diabetes among others.

Including the wellness program funding in work places will help improve the declining health of

the aging people. A very significant advantage of these programs is that they are cost-beneficial,

saving organizations money in healthcare expenditures and producing a positive return on

investment.

CLINICAL PRACTICE GUIDELINES 7

Like any other system the healthcare system is facing and will continue to face some

challenges now and then. In past years there have been reports of lack of patient respect by

doctors in different hospitals. Some patients have had very lengthy stays in the hospitals too.

This can be termed as a challenge and in other cases doctors fail to help in prevention of diseases

in cases that would have been easily prevented. In addition, the rising health care costs are a

major challenge in the healthcare system. The issue comes down to reimbursement and revenue.

Medicare and Medicaid reimbursement levels do not cover the cost of care. This forces the

hospital administrations and the doctors to squeeze costs out of the system while trying to keep

good quality and patients’ safety. The system also lacks focus on health and puts more of the

focus on illnesses. Similarly, the system focuses more on a group of clients than on a population.

Recently individuals are being asked to pay more for their own healthcare. This issue will

lead to those with higher incomes being able to afford a wider range of healthcare services while

those with lower incomes will have a challenge getting these services. There are some theories

that the number of uninsured people has been on the rise since the economy softened and the

number of people with employer- sponsored coverage decreased. Research shows that the

uninsured do not receive as good healthcare services as those who are insured. This leads to them

suffering serious health consequences or even financial problems if they get the right care. As a

result local health care systems strain financially when providing care for a large uninsured

population. This will in future cause the system to collapse from the increasing financial pressure

if the number of the uninsured individuals continues to grow.

In as much as new technologies are invented in order to make life easier, they can also

turn out to be a challenge in the system. Many of the newly invented drugs and machines are

expensive and very hard for most of the public to afford. The government and the system are still

CLINICAL PRACTICE GUIDELINES 8

trying to find ways in which they can help cover some of these treatments by insurance but this is

yet to be fully put into place. Lack of comprehensive coverage may discourage pharmaceutical

companies from developing products that are clinically beneficial but not rewarding financially.

The actual cost of giving services related to the delivery of health care which includes the cost of

procedures, therapies and medication is what is termed as health care cost for consumers. The

health care cost for consumers has sky rocketed in the past few years (Brill, 2015). This has

caused the consumers to rant and complain over the high prices they now have to pay for the

health care services they receive. Health insurance keeps going up. The amount of money one

has to add for prescription drugs is going up too and all this is because their costs are also going

up.

The healthcare system has significant ways of combating some of the challenges it is

facing. The system is therefore trying to come up with ways to put the patient at the center of

care. This will help improve patient satisfaction and involvement. The shift from acute care to

wellness prevention and accountability is also one of the major ways in which the health care

system is trying to handle these challenges. Emphasis on wellness for the population rather than

cure for diseases, trying to improve the process efficiency and paying close attention to cost

centers are some of the visible efforts that the health care system is trying to use in dealing with

the challenges it faces. Another plan that seems to be taking effect is consolidation; this is where

the most successful hospitals are merging with or absorbing the least successful ones. The

intention is to create a system of integrated and accountable care. This will lead to achievement

of both quality and cost effectiveness.

A Community Program

CLINICAL PRACTICE GUIDELINES 9

One viable community program that can be arranged is a public lecture at a renowned

institution and invite the public. the program can be conducted by the state department of public

health in conjunction with the children department and the administration of the organization to

come up with an awareness program where public lectures can be given to make people aware of

the effects and early detection mechanisms they can use to know disability in their children.

Expositions at the seminar can touch on mental and physical disabilities and how to handle them.

The awareness campaign can be used as a forum to educate people on how to handle children

with disabilities. The program can be scheduled for five hours for one week on a biannual

arrangement.

Additional opportunities available

The educational initiatives named above provide their learners with some other

opportunities to better their skills in the health industry. Through the community-based initiative,

the programs can offer the students with a more diverse opportunity of experiencing the real

health sectors and how different duties are carried out. Also, they present the students with

opportunities of being able to develop commitment in their career paths and also to be able to

improve their relationship with different people. Through these opportunities, the students can

establish and enhance new ideas that would positively impact the health industry. The students

are more enlightened about the different communities around them, the health risks that these

communities face and how they would contribute to minimizing these risks. Both educational

programs are working to their best to produce better medical professional for a better health

industry (Institute of Medicine, 2013).

Building a Relationship

CLINICAL PRACTICE GUIDELINES 10

One strategy that can work is that of building a relationship between the two centers

involved in a child’s welfare. This can be referred to as building relationships through starting up

family centers that can be able to offer learning materials that learners can borrow from and

make use of in their studies (Best Start Resource Center, 2011). The other activity in the strategy

is making visits to families which have just set up roots in the institution. Activities can also be

held so as to honor the contributions that families make to the institutions in question. One other

way is to set the building as open for use by families in the community and the social services

that have been made available like vaccinations etcetera.

Linking to Learning

The activities that families are connected to have a link established to the learning

process for the child in question. The teachers and parents are involved in the work the student

does and the testing process. The parents and teachers can also initiate special programs such as

extra tuition, tutoring and homework programs where the progress a student makes is monitored

in the process.

Addressing Differences

Differences are addressed through the work done by translators. The teachers and parents

work hand in hand to embrace the diversity occurring in the organization; this is where books

and materials concerning different cultures are encouraged for use to establish that unity. The

Parents and Teachers Association does not bar any family from being a participant.

Sharing Power

The issues involving prejudice and tracking are issues that can be researched upon by

parents. The group of parents focuses on improving the prospects of student achievement where

CLINICAL PRACTICE GUIDELINES 11

families get involved where major decisions are being made. Parents can also be involved by

making use of the facilities provided by the school.

Increase in Stress and Other Effects

A disabled child increases stress for the parents of the child in question. It also affects the

mental and physical health of the family because of the stress that comes with having such a

child. It is difficult to obtain proper care for the child (Scully, Barbour, & Roberts-King, 2014).

The decisions made at the place of work are greatly affected by the disability of a child at home.

Decisions that are affected include the decision to have more children, the decisions at the place

of work, and the decisions on education and training for the child. The child also tends to rely on

the support given to him or her by the public. There is reduced esteem in the family and also

guilt and self-blame. Other aspects of attention within the family become diverted. The costs

incurred in medical care on an out-of-pocket basis may be very large. There are also effects on

the quality of life that the two parents involved live. The living arrangement that the parents have

between themselves and the structure of the family also becomes affected.

Organizing a Seminar

Seminar can be scheduled on a regular basis at the childhood organization to facilitate the

process of making people know about disabilities and their effects to the family. A seminar can

help in providing insight to those in attendance so that they can be able to use the information

acquired to deal with the situation of disability in the family. Such a seminar can be organized

for parents who have children in the organization suffering from various disabilities. It can be a

forum where they can invite other parents. The information being shared can be based on the

ways of handling various disabilities in children.

CLINICAL PRACTICE GUIDELINES 12

References

An, S.-Y., Seo, K.-S., Kim, S., Kim, J., Lee, D.-W., Hwang, K.-G., & Kim, H. J. (2016,

December). Developmental procedures for the clinical practice guidelines for conscious

sedation in dentistry for the Korean Academy of Dental Sciences. Journal of Dental

Anesthesia and Pain Medicine, 16(4), 253–261. doi:10.17245/jdapm.2016.16.4.253

Brill, S. (2015). America’s Bitter Pill. New York, NY: Random House Publishing Group.

Burbano-Paredes, C. C., Amaya-Guio, J., Rubiano-Pinzón, A. M., Hernández-Caicedo, Á. C., &

Grillo-Ardila, C. F. (2017, July–September). Clinical practice guideline for the

management of sedation outside of operating room in patients over 12 years. Colombian

Journal of Anesthesiology, 45(3), 224-238. doi:org/10.1016/j.rcae.2017.03.006

Community Catalyst. (2010). Summary of the Affordable Care Act. Retrieved June 13, 2017,

from Community Catalyst: http://www.communitycatalyst.org/doc-

store/publications/ACA_Summary-1.pdf

Jones, D. D., & Heaton, H. A. (2017, February 1). Pediatric Procedural Sedation. Retrieved July

19, 2018, from AHC Media: https://www.ahcmedia.com/articles/140040-pediatric-

procedural-sedation

Weisz, G., Cambrosio, A., Keating, P., Knaapen, L., Schlich, T., & Tournay, V. J. (2007,

December). The Emergence of Clinical Practice Guidelines. The Milbank Quarterly,

85(4), 691–727. doi: 10.1111/j.1468-0009.2007.00505.x

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