Central state hospital

USE OF MINIMAL SEDATION FOR CLINIC APPOINTMENTS AND
DIAGNOSTIC PROCEDURES


INTRODUCTION
Clients who are anxious or unable to cooperate for necessary diagnostic tests and treatments may
benefit from low doses of medications to alleviate anxiety and improve the individuals ability to
cooperate. These medications should be administered on the living units prior to transport to the
appointment. In general, these medications are not administered in the clinics and clients
requiring heavier sedation, including conscious sedation and IV procedures, must be managed in
Clinical and Consultative Services (eg ECT, Radiology).
PURPOSE
The purpose of this policy is four-fold: 1) to define minimal sedation acceptable for clinic
appointments and procedures and administered outside Clinical and Consultative Services; 2) to
identify the persons who are authorized to prescribe and administer these medications; 3) to
establish the evaluation and monitoring requirements for clients receiving these medications; and
4) to outline prescribing requirements and provide a table of approved medications which may
be used.
DEFINITION
Only minimal sedation may be administered and utilized outside of Clinical and Consultative
Services. Minimal sedation is defined as a drug-induced state during which the individual client
responds normally to verbal commands. Although cognitive function and coordination may be
impaired, ventilatory and cardiovascular functions are unaffected.

QUALIFICATIONS

Physicians who are familiar with the indications, complications, and effects may prescribe these
medications. With a physicians order, licensed nurses may administer these medications
provided that they have demonstrated competence in PO and IM routes of administration, client
evaluation, measurement of vital signs and the performance of emergency medical procedures.
EVALUATION
The physicians must evaluate the client’s medical status, current medication regimen, and
previous experience with these medications in order to select an appropriate medication, dose of
medication and route of administration.
The nurse must check the client’s vital signs and review the client’s chart for allergies and
adverse reactions prior to medication administration. Should the nurse identify an allergy or
adverse reaction to the prescribed medication, the medication must be held and the physician
contacted for further orders. The nurse will notify the physician immediately if abnormal vital
signs and/or changes in the client’s general medical condition are noted prior to and/or after
administration of the sedation medication.
MONITORING
Vital signs will be measured and recorded prior to administration of the sedative medication
ordered. Vital signs will be measured and recorded 15 to 30 minutes following administration of
the medication, and every hour thereafter until the client is transported to the appointment.
Abnormal vital signs or significant changes in vital signs will be reported to the physician
immediately. In the event that abnormal vital signs and/or significant changes in the condition of
the client are noted, the client will not be released to the transportation staff for transport to the
appointment until the client is evaluated by the physician and transport is approved by that
physician.
Clinics/diagnostic areas receiving clients who have been pre-medicated must have internal
policies and procedures which provide for acceptable client monitoring and emergency medical
response. Clinics should be equipped with emergency drugs approved by the CSH Medical
Staff, positive pressure emergency oxygen, and automated external defibrillators. Clinic staff
should be trained in early recognition of medical emergencies and should be prepared to activate
Emergency Medical Services and provide basic life support, including emergency cardiac
defibrillation.
Following completion of the clinic appointment and after the attending staff (medical or dental)
has determined that the client is stable for transport, the client shall be released to transportation
services for return to the parent unit.
Upon arrival at the parent unit, the nurse will measure and record the client’s vital signs. The
client will be monitored in accordance with CSH Nursing Policy and Procedure regarding

minimal sedation and per physicians order. The physician will be immediately notified should
any abnormal vital signs or changes in condition of the client be noted.
PRESCRIBING REQUIREMENTS
The smallest dose required to achieve the desired level of relaxation should be prescribed. The
dose may be titrated up as needed over subsequent clinic appointments provided minimal
sedation levels and maximum doses are not exceeded. A table of approved medications which
includes typical and maximum dosages is included in this policy. Whenever possible, the oral
route should be selected as it is less invasive to the client. The Haldol plus Ativan combination
should be used only after the single medications have proven to be ineffective in achieving
minimal sedation appropriate for the clinical evaluation or procedure to be done.
A physician may exceed the maximum recommended dose only with the clinical director’s
approval. In these situations the prescribing physician must write a progress note justifying the
higher dose and the record must reflect previous attempts at the maximum dose resulting in little
or no sedative affect. The clinical director must make a similar supporting progress note.
A physician may prescribe a medication not on the approved list only with the clinical director’s
approval. In these situations the prescribing physician must write a progress note justifying the
alternative medication and the record must reflect little or no sedative affects with the approved
medications. The clinical director must make a similar supporting progress note.
PO includes through the gastrostomy tube.
The dose of medication must be modified for the elderly and infirmed and based on weight.
APPROVED:
This policy has been approved by the CMO and CEO on 1/05.

Source: http://centralstatehospital.org/policy/Policy4.54.pdf