Willem Beekhuizenn

Speeches:

• Intraveneus sedation by non-anaesthetists: Implementation of Dutch national guidelines -Rome 2006 - 13 Ottobre 2006, 02:00
  

  Intraveneus sedation by non-anaesthetists: Implementation of Dutch guidelines
  Willem Beekhuizen, MD, CASA clinics The Netherlands
  In this communication the implementation of the Dutch guidelines for deep intravenous
  sedation in four abortionclinics is reported. Our experiences may be helpful to other
  professionals who are considering to offer intravenous sedation to women who prefer to
  have a painless procedure.
  Safe and effective intravenous sedation requires strict adherence to guidelines when
  administered by physicians who are not anesthesiologists. For that reason national
  guidelines were developed in several countries, including The Netherlands, with
  cooperation of the Dutch association of anesthetists.
  The recommendations in the published guidelines should be used for the formulation of
  local protocols in hospitals and clinics and adjusted to the specified speciality and
  procedure. However, several years after publication of the guidelines, a number of
  countries report a serious lack of implementation of existing guidelines. At present (2006)
  the 1998 Dutch guidelines are evaluated and it seems that Dutch abortion doctors are one
  of the few subspeciality organizations that formulated interdisciplinairy sedation protocols
  appropriate to clinical practice in abortion clinics.
  In July 2001 the management of the Dutch CASA-clinics contracted an advisory
  anaesthetist and nominated a abortion doctor and a dedicated professional for quality
  development to collaborate in the local implementation of guidelines, starting in a single
  clinic. Protocols for formal multidisciplinary team training in sedation and resuscitation and
  for the availability of appropriate equipment and drugs were formulated. The clarification of
  the different responabilties of the teammembers in the process required special attention.
  We will present examples of Procedure descriptions and Work Instructions in the Free
  Communication. The anaesthetist advised to change to a single drug system: only propofol
  iv is administered as a sedative drug. Possible adverse consequences of intravenous
  sedation were identified and protocols formulated how to deal with these.
  Requirements for both theoretical and practical training were formalised. For each
  candidate a personal plan for training was drawn up, depending on his previous
  experience. Trainingplans include: 

  Clinical lessons by the anaesthetist, a pharmacologist and an abortiondoctor
  Guideline-texts, Documents of the existing quality system such as Process Descriptions
  and Working Instructions for both doctors and nursing staff
  Legal and formal aspects of anaesthesia and sedation, responsabilities
  Training in skills such as life support, defibrillation and treatment of advesre incidents such
  as anaphylactic reactions
  A final practical and theoretical exam by the anesthetist completes the training, and a
  certificate is granted.
  On-going audit of complications was organised within the existing clinical quality
  framework of blamefree reporting of accidents or near accidents.
  In 2003-2005 this program for safe sedation practice was extended to three more CASA-
  clinics.
  Plans for the near future include:
  An audit in all clinics to check compliance with protocols.
  Construction of a skillslab (inspired by the well known ATLS-training)
  Construction of a module in the CASA-EPR for specific recording of sedation related
  (near)complications

  Incorporation of safe sedation practice into training and revalidation programmes of the
  national NGvA (Dutch association of abortion doctors)