非麻醉医师执行镇静业务-从jci经验看麻醉科如何把关.pptVIP

非麻醉醫師執行鎮靜業務－從 JCI 經驗看麻醉科如何把關? 前言 JCI條文 準則之制定 執行面 ASC 3. ME 1ASC 3. ME 2 Appropriate policies and procedures, addressing at least elements a) through f ) found in the intent statement, guide the care of patients undergoing moderate and deep sedation The qualified individual(s) identified in ASC.2 participates in the development of the policies and procedures. How to do? 明確鎮靜照護標準並書面化、標準化，提供一致性、完整性的鎮靜照護，提升鎮靜業務的醫療品質。 避免因人員或科別不同而照護政策不一致。 由麻醉科主任及負責醫師主導，和各相關科主任討論訂出policies and procedures 深度鎮靜政策 中度(有意識)鎮靜政策 哪些科別醫師？ 發函給各科主任調查 誰有使用過鎮靜藥物 不適用範圍 在重症單位使用肌肉鬆弛劑之病人 使用藥物來改善病患在某些醫療處置後或者因疾病進展所造成之疼痛 使用藥物使病患能有較好的睡眠品質 ASC 3 ME 3 There is a presedation assessment, according to organization policy, to evaluate risk and appropriateness of the sedation for the patient. Patient counseling(同意書） Benefits Risks Limitations Possible alternatives to sedation and analgesia ASC 3. ME 4 The qualified practitioner responsible for the sedation is qualified in at least elements g) through k) in the intent statement Qualifications Techniques of various modes of sedation Appropriate monitoring Response to complications Use of reversal agents 醫師教育認證及資格審查 給予有需求的醫師上課及課後考試 符合本院policies者給予認證 鎮靜授權計畫書 授權類型 中度之授權 重度及快速插管(Rapid sequence intubation)授權 授權方式 全院演講 課後上E---learning課後評值 需有期效內ACLS證照 期限 如何控管 藥物控管 中度鎮靜: BZD，Chloral hydrate 重度及快速插管: Propofol，Barbiturates，ketamine，droperidol , etomidate, SCC 電腦管控 查核使用情況 ASC 3. ME 5 A qualified individual monitors the patient during sedation and during the period of recovery from sedation and documents the monitoring. 護理技術人員 給予上課認證 需具備BLS證照 期限 查核記錄單張填寫 How to monitor Moderate sedation Deep sedation Moderate sedation Level of consciousness Oxygenation status Pulse oximetry with appropriate alarms Ventilatory function Observation or auscultation Blood Pressure ( Electrocardiographic monitoring ) Deep sedation Level of consciousness Oxygenation status Pulse oximetry with appropriate alarms Ventilatory function Monitoring of exhaled carbon dioxide Blood Pressure Electroc