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The department of anaesthesia should be involved in the design and planning of any service requiring the provision of anaesthesia or deep sedation.⁶³

Patients meeting discharge criteria following anaesthesia or sedation who are to be discharged home should be discharged into the care of a responsible third party. Verbal and written instructions for post-procedural care should be provided if a procedure has been performed.⁶⁷

A named anaesthetist should be responsible for liaising with consultants in other departments with responsibility for sedation, to establish local guidelines and training for the provision of safe sedation by non-anaesthetists.^1,65

Each facility should develop written policies, designating the types of operative, diagnostic and therapeutic procedures requiring anaesthesia or sedation.

Guidelines for the management of rare emergencies must be prominently displayed at all sites where sedation is administered.

Midazolam over sedation during sedation is defined as a ‘never event’ by the Department of Health.⁶⁶ Hospitals should report these incidents to the National Reporting and Learning System.

All institutions where sedation is practised should have a sedation committee. This committee should include key clinical teams using procedural sedation and there should be a nominated clinical lead for sedation. In most institutions, the sedation committee should include an anaesthetist, at least in an advisory capacity.

There should be a multidisciplinary programme for auditing anaesthesia and sedation in the non-theatre environment.

Audit should be under regular review by a clinical lead and those relating to sedation should be coordinated by a hospital sedation committee.

Regular feedback and improvement of standards should be provided to anaesthetic staff.