A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Abstract

Aim Worldwide, health‐care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board‐certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan. Methods We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre‐ and post‐intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t‐test. Results One hundred and forty‐four health‐care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre‐ and post‐intervention knowledge questions. Before the training, participants scored an average 66% (63%–69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%–20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre‐PSA systematic evaluation. Conclusion Our educational intervention successfully increased participants' knowledge. Only the minority of health‐care providers use capnography routinely for PSA, and pre‐PSA evaluation is not commonly carried out.

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study

“… 19 Similar to propofol for PSA, routine supplemental oxygen may reduce the incidence of hypoxia for the elderly patients receiving thiopental. Notably, capnography is not routinely used in Japanese EDs, 20 thus transient apnea may be overlooked. The incidence of hypoxia could be explained by overlooked apnea; thus, routine use of capnography might need to be considered.…”

“…Second, the type of monitoring and timing of measurements depended on the physician who performed PSA. Japanese EDs do not routinely use capnography, 20 thus transient apnea may be overlooked. Likewise, the incidence of hypotension in our study was low but may be overlooked due to long noninvasive blood pressure measurement intervals.…”

A mini‐review of procedural sedation and analgesia in the emergency department

“…The course evaluation results showed that health care professionals who participated in the training had a somewhat limited baseline knowledge of pharmacology, elderly patients, timing of AEs, and fasting time on PSA, and that the knowledge was significantly improved after the training. 11 In the sections which follow, we describe concrete procedures for safe PSA in the ED. These procedures include, an evaluation of the patient by an EP, who will also plan for sedative levels and medications.…”

“…Second, indications for PSA in the ED are different (Table 1). 2,4,5 Third, emergency physician (EP) training opportunities for PSA in Japan are somewhat limited 11 . The Japanese Procedural Sedation and Analgesia Registry (JPSTAR), a multicenter prospective observational study, showed slightly higher incidence of adverse events (AEs) during PSA in participating EDs in Japan than previous studies in other countries 2 .…”

“…The Japan Society of Procedural Sedation and Analgesia (JSPSA) developed a PSA training course in order to meet the need for training in Japan and other countries in Asia. The course evaluation results showed that health care professionals who participated in the training had a somewhat limited baseline knowledge of pharmacology, elderly patients, timing of AEs, and fasting time on PSA, and that the knowledge was significantly improved after the training 11 …”