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As a result of the continuum of depth of anaesthesia, individuals administering moderate sedation should be able to rescue patients who enter deep sedation. Those administering deep sedation should be adequately trained to rescue patients who enter a state of general anaesthesia. This requires skilled anaesthetic assistance and equipment and involves the potential for airway intervention and support of both...

Sedation practitioners should maintain a logbook of cases performed and adverse incidents reported.

Patient safety is, as always, of paramount importance. Particular attention should be paid to teamwork, communication, the use of checklists and procedure brief when working in less familiar environments. At the team briefing, an explicit plan should be agreed for requesting help if required, recognising the risk of, and preparing adequately for, high blood loss, and life-threatening loss of the...

Many patients undergoing elective procedures outside the operating theatre can be managed as day cases and should be assessed accordingly in conjunction with local guidelines. All patients should undergo an appropriate risk assessment and level of preoperative assessment in line with the GPAS recommendations in Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent...

Hospitals should have a system for multidisciplinary involvement in reporting and regular audit of critical incidents and near misses. A risk register should be maintained for all remote locations in the hospital.

Environmental hazards such as radiation exposure, MR fields and lack of a scavenging system should be considered by staff before the start of each list. Volatile agent scavenging canisters, air-oxygen mixtures and avoidance of nitrous oxide can mitigate environmental risks. Consider TIVA where adequate scavenging cannot be achieved. Personnel who are pregnant may be particularly at risk in these environments...

In remote offsite 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 by any staff members at a remote location (e.g. ECT in a psychiatric hospital), arrangements should be made to perform the procedure...

Documentation to the standard used in the operating theatre should be kept for all patients and this should include the grade and specialty of the doctor performing and supervising the anaesthetic, together with the name of the supervising consultant designated to provide direct or indirect advice.²⁴ Access to the electronic patient record and medical notes should be available at...

The department of anaesthesia should be involved in the design and planning of any service requiring the provision of anaesthesia or deep sedation. A regular review of the remote location performance, critical incidents and further improvements should be held.⁸⁷

Patients meeting discharge criteria following anaesthesia or sedation 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 outlined in Chapter 6: Guidelines for the Provision of Anaesthesia Services for Day Surgery.⁸⁸