RESUMO
Introducción: la sedación mejora sensiblemente la calidad de la endoscopia digestiva, aunque puede tener complicaciones graves. Métodos: protocolo multidisciplinar en base a la joint comission que defina el protocolo de sedación por no anestesiólogos. Se excluyen pacientes ASA 4 o con vía aérea difícil, pruebas complejas y sedación profunda. Controlamos la calidad en base al análisis de 9 indicadores. También se monitorizan las pruebas incompletas para valorar eficacia. Resultados: la seguridad del paciente se establece en base a una incidencia de complicaciones muy baja, con una incidencia de eventos respiratorios de 1,07. Además, se encuentra una baja incidencia de hipotensión y bradicardia, al igual que del dolor durante y después de la endoscopia y una incidencia menor del 0,5% de ingresos no esperados. Los indicadores de calidad medidos nos indican la evolución de los resultados del programa. Conclusiones: la monitorización continuada de los programas de sedación en endoscopia permiten controlar las diferentes dimensiones de la calidad e implementar medidas que mejoren el proceso
Introduction: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. Methods: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. Results: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. Conclusions: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Sedação Consciente/métodos , Anestésicos/administração & dosagem , Monitoramento de Medicamentos/métodos , Endoscopia do Sistema Digestório/métodos , Estudos Prospectivos , Protocolos Clínicos , Unidades Hospitalares/organização & administraçãoRESUMO
INTRODUCTION: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. METHODS: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. RESULTS: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. CONCLUSIONS: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement.
