Procedural sedation and analgesia (PSA) is commonly performed in the Emergency Department (ED). The semi-elective nature and the medications involved, PSA represents one of the highest risk procedures perforemed in the ED. Given the high-risk nature, documentation is paramount to ensure safety is maintained and quality reviewed. We aim to describe the current practice of PSA in an Australian tertiary mixed ED and to examine the quality of documentation in this setting.
A retrospective observational study of the first 3 months of a PSA registry as part of the Tasmanian Emergency Care Outcomes Registry was analysed with a focus on documentation by both medical and nursing staff.
80 consecutive PSA cases were entered over a 3-month period between 1st January and 30th March 2022 from a single tertiary hospital. Joint reductions (39%) and fracture reductions (29%) were the most common indications for the adult population whilst fracture reduction (36%), laceration repair (7, 28%) and other distressing procedure (28%) were most common in the pediatric cohort. No severe events occurred for either cohort. When assessing the PSA specific documentation, completion rate for variables on the form ranged from 50% (prior anaesthetic) to 99% (pharmacological prescriptions). For nursing led documentation, pre-procedural vital signs were missing in 44% of patients.
PSA is frequently and safely performed in our tertiary mixed-ED. Documentation of this high-risk procedure is unsatisfactory for both medical and nursing led categories. Future research should explore the barriers to completing documentation.