In remote off site locations, such as psychiatric hospitals where anaesthesia is provided for ECT, advanced plans should be made to manage patient transfer if required.
If there is any concern about the safety of the procedure being undertaken at a remote location, for example ECT in a psychiatric hospital, then arrangements should be made to perform the procedure in an operating theatre environment.
Documentation, to the standard used in the operating theatre, should be kept for all cases and this should include the grade and specialty of the doctor performing and supervising the anaesthetic along with the name of the supervising consultant designated to provide direct or indirect advice.19 Access to the electronic patient record should be available at all remote sites.
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
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.
