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ABSTRACT
Moderate sedation and analgesia (MSA) can help patients experience less anxiety and discomfort, tolerate procedures that do not require general anesthesia, and maintain the ability to respond to verbal commands. Nurses administer MSA in a variety of clinical areas, and facility leaders may have difficulty creating a single standard of care for this task. Completion of a presedation assessment that includes the patient in the decision-making process is an important aspect of care. When administering MSA, nurses should have immediate unrestricted patient access and no competing responsibilities that could distract them from monitoring and assessing the patient. Nurses should complete education and competency verification activities before administering MSA. AORN recently revised the "Guideline for care of the patient receiving moderate sedation/analgesia," and this article addresses the standard of care, the presedation assessment, patient monitoring, and competency; it also includes scenarios describing specific concerns in two patient care areas.
Key words: moderate sedation and analgesia (MSA), standard of care, presedation assessment, obstructive sleep apnea (OSA), patient monitoring.
Since the 1980s, clinicians have used moderate sedation and analgesia (MSA)-also known as conscious or procedural sedation-to provide patients comfort during procedures that may be difficult to tolerate when awake but do not require general anesthesia.1 Moderate sedation and analgesia provides the patient with both pain and anxiety relief during procedures while still allowing him or her to respond to verbal commands; it also facilitates a faster recovery.
The recently revised AORN "Guideline for care of the patient receiving moderate sedation/analgesia"2 provides direction and guidance to RNs who administer MSA in perioperative and non-OR procedure areas. The guideline includes information on the scope of nursing practice, performing a presedation patient assessment, medication administration, discharge readiness criteria, education, policies and procedures, and quality.2 The AORN project team assessed the available evidence and made recommendations when the benefits of the initiative clearly would exceed the harms; in general, high- to moderate-quality evidence supports recommendations.3 The project team made conditional recommendations when the benefits of the initiative likely would exceed the harms; any level of evidence supports conditional recommendations under certain conditions. The evidence table for the MSA guideline can be found at https://aorn. org/-/media/aorn/guidelines/evide nce-rating-and- tables/evidencetable-mod-sed-0621.pdf.
This article provides an overview of the standard of care for administering MSA,...