Audit of sedation, analgesia and anaesthesia in radiology [QSI Refs: IR-801, MR-809]

Tool for assessing the safety and efficacy of sedation and analgesia in the setting of radiological procedures.

This tool is designed to be used in conjunction with Sedation, analgesia and anaesthesia in the radiology department, Royal College of Radiologists, second edition.

The standard: 

An appropriately trained and credentialed team should administer sedation and analgesia.

Patients requiring sedation should undergo pre-procedure assessment and have a sedation plan.

A World Health Organization (WHO) checklist should be used for every sedated case.

Sedated patients should be appropriately monitored.

Resuscitation equipment and reversal agents should be readily available.

A properly staffed recovery area and formalised communication are essential for safe after-care and discharge.

Target: 

100% of these criteria should be met.

Indicators: 

The person administering sedation should have appropriate training in line with local and national guidance

Documented pre-procedure assessment and sedation plan should be available in the notes

Completed WHO checklist including sign-in and sign-out should be available for every case

Appropriate monitoring should be used for all cases. Observations should be recorded in a legible way, with an appropriate frequency of measurement

Resuscitation trolley and drug inventory should be checked daily and signed for

Documented hand over and written discharge information should be available for every patient

Data items to be collected: 

A retrospective audit of 10-20 consecutive radiology cases having sedation should be undertaken, with each one of the above indicators assessed for each case.

Suggested number: 

30-50

Where the target is not met, action should be taken promptly to ensure the target is achieved and a repeat audit undertaken. If the targets are achieved, then a routine audit should be undertaken annually to ensure safe standards of practice are maintained.

Staff training records

Patient notes

Resuscitation equipment log

1. Academy of Medical Royal Colleges. Safe sedation practice for healthcare procedures. Standards and guidance. London: Academy of Medical Royal Colleges, 2013

2. World Health Organization. Surgical safety checklist. Geneva: World Health Organisation, 2009.

3. Lee MJ, Fanelli F, Haage P, Hausegger K, Van Lienden KP. Patient safety in interventional radiology a CIRSE IR checklist. Cardiovasc Intervent Radiol 2012: 35: 244–246. American College of Radiology and Society of Interventional Radiology. ACR–SIR practice parameter for sedation/analgesia. Reston: American College of Radiology, 2018.

4. Royal College of Anaesthetists. Guidelines for the provision of anaesthetic services (GPAS). London: Royal College of Anaesthetists, 2017.

5. The Royal College of Radiologists.Speciality training curriculum for clinical radiology. London:The Royal College of Radiologists, 2016.

6. The Royal College of Radiologists. Sub-specialty training curriculum for interventional radiology. London: The Royal College of Radiologists, 2016.

7. Berkenbosch JW. Options and considerations for procedural sedation in pediatric imaging. Pediatr Drugs 2015; 17(5): 385–399

Dr Caroline Rubin

Co-authors

Dr M Gibson, Consultant Radiologist, Royal Berkshire Hospital, Reading (chairperson)

Dr J Briggs, Consultant Radiologist, Royal Berkshire Hospital, Reading

Dr K Place, Consultant Anaesthetist, Royal Berkshire Hospital, Reading

Dr R Thomas, Consultant Radiologist, Imperial Hospital, London

Dr S Chippington, Consultant Radiologist, Great Ormond St Hospital, London

Dr E Stockton, Consultant Anaesthetist, Great Ormond St Hospital, London