Authors (including presenting author) :
Leung WH, Lau TL, To PS, Wu CC, Wong WS,Wong YY, Tang CM, Chan YT, Kwok YS, Chiu TY
Affiliation :
(1)Endoscopy Centre, Department of Surgery, Yan Chai Hospital
Introduction :
Conscious (moderate) sedation is generally used for endoscopic examination to reduce pain and discomfort in order to improve patient satisfaction and successful rate of endoscopy. Spontaneously, nurses need to devote more effort and time to provide timely care, constant monitoring and precise documentation to meet the needs of the sedated patient during or after the examination. Since 2017, a fast- track discharge scoring system has been developed to assess post sedated patient which is for optimizing the nursing record system and promoting safe patient discharge of the endoscopy center with reference to a set of criteria.
Objectives :
To evaluate the effectiveness of the scoring system for discharging patients who have undergone endoscopic procedures with sedation. Hypothesis: The fast-track scoring system could help nurses to early identify patients, who are at risk of developing complications related to the endoscopic procedure or the sedation used, ensure prompt interventions to reduce unplanned admissions, resuscitations or even deaths of patient.
Methodology :
Methodology: In reviewing individual documentation of YCH Endoscopy Center, all nurses have addressed to the principles of patient safety; nursing outcome and effectiveness to modify the endoscopy nursing records. Finally, 8 criteria were identified for implementing the discharge scoring system in accordance with the components recommended by the Hong Kong College of Anesthesiologists. They are namely: blood pressure; pulse/heart rate; oxygen saturation/end-tidal CO2; respiratory rate; consciousness; mobility; body temperature; reaction of protective reflexes, and supplementary pain assessment. Each criterion should be assessed and scored on the basis of the descriptors indicated from mark 0 & 1. Patient can only be discharged from Endoscopy Centre when they meet the discharge criteria with score 8.
Result & Outcome :
Outcome: From Nov 2017 to Oct 2020, 11550 patients with gastrointestinal endoscopic procedures performed under conscious sedation were discharged directly by EC nurses. 8 patients in recovery room who had declining medical condition were early detected and managed effectively with positive outcomes. From Sep to Oct 2020, 309 outpatients underwent colonoscopy with sedation were safely discharged. The length of recovery time after endoscopic treatment were about 1 -2.5 hours. The whole patient journey took only 2.5-4.5 hours from register to discharge. As a result of the scoring system was worked out after drawing reference to international pratices and the uniqueness of patient workflow. EC nurses opined that the scoring system was able to provide an objective and impartial approach to assess patient condition for enhancing discharge safety in a timely and appropriate way as well as boosting confidence in discharging patients home directly from the endoscopy center.
