Policy Under Review

Please note that this policy is under review. It does, however, remain current Trust policy
subject to any recent legislative changes, national policy instruction (NHS or Department
of Health), or Trust Board decision. For guidance, please contact the Author/Owner.

Information Category Detailed Information

Procedural Sedation of Adult Patients in the

Document Title:
Emergency Department Clinical Guideline V2.0
This document replaces (exact Procedural Sedation of Adult Patients in the
title of previous version): Emergency Department Clinical Guideline V1.1

Date Issued / Approved: February 2022

Date Valid From: February 2022

Date Valid To: August 2025

Author / Owner: J Bareham, ED Consultant

Contact details: 01872 252452

The purpose of this guideline is to improve patient

safety and quality of care by setting standards for
Brief summary of contents: the safe sedation of adult patients in the ED. The
guideline sets training standards and requirements
for ED clinicians delivering sedation.
Suggested Keywords: Sedation, Emergency Department.
RCHT: Yes
Target Audience: CFT: No
CIOS ICB: No
Executive Director responsible
Chief Medical Officer
for Policy:
Emergency Department Governance Group.
Approval route for consultation
and ratification: Urgent, Emergency and Trauma Governance
Group.

Manager confirming approval

Racheal Pearce
processes:
 Information Category Detailed Information

Name of Governance Lead

confirming consultation and Paul Evangelista
ratification:

Links to key external standards: None required

The Royal College of Anaesthetists and The
College of Emergency Medicine Working Party on
Sedation Anaesthesia and Airway Management in
the ED. Safe Sedation of Adults in the ED.
November 2012
The Royal College of Emergency Medicine Best
Related Documents:
Practice Guidelines, Pharmacological Agents for
Procedural Sedation and Analgesia in the ED. May
2016
American College of Emergency Physicians.
Procedural Sedation and Analgesia in the ED.
October 2013
Training Need Identified: yes
Publication Location (refer to
Policy on Policies – Approvals Internet and Intranet
and Ratification):
Document Library Folder/Sub
Clinical / Emergency Department
Folder:

This document is only valid on the day of printing.

Controlled Document.

This document has been created following the Royal Cornwall Hospitals NHS Trust Policy
on Document Production. It should not be altered in any way without the express
permission of the author or their Line Manager.

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 2 of 22
 Procedural Sedation of Adult Patients in
the Emergency Department
Clinical Guideline

V2.0

February 2022

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 3 of 22
Summary

Pre-Procedure Checklist

Staff, Location, Equipment, Documentation Patient Assessment

• Staffing: Minimum of three staff required for • ASA Grade documented: Only ASA I, II and
all procedural sedation. Sedation only to be selected grade III patients for sedation in
performed by trained clinicians the ED. No ASA IV or V patients to be
• Location: Level 2 moderate sedation sedated without discussion with senior
(midazolam & opiate) minors theatre or anaesthetist
resus. Level 3 deep sedation (propofol) or • Airway Assessment complete: No patient
dissociative sedation (ketamine) resus only with feature of difficult airway to be sedated
• Equipment: Resus equipment available without discussion with senior anaesthetist
• Documentation: ED sedation pro-forma
completed

During sedation
• All patients to be on continuous monitoring including ECG, NIBP, pulse oximetry, end-
tidal CO2
• All patients to have 15L oxygen via non-rebreather mask
• Documentation
▪ Observations every 5 minutes
▪ Level and depth of sedation
▪ Adverse events
▪ Discharged with responsible adult
• Written sedation patient information

Post sedation

• Criteria for discharge

▪ Return to normal level of consciousness
▪ Normal vital signs
▪ Pain, nausea and vomiting controlled
▪ Discharged with responsible adult
• Written sedation patient information

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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1. Aim/Purpose of this Guideline
1.1. The purpose of this guideline is to improve patient safety and quality of care by
setting standards for the safe sedation of adult patients in the ED. The guideline
sets training standards and requirements for ED clinicians delivering sedation.

1.2. This version supersedes any previous versions of this document.

Data Protection Act 2018 (General Data Protection Regulation – GDPR) Legislation

The Trust has a duty under the Data Protection Act 2018 and General Data Protection
Regulations 2016/679 to ensure that there is a valid legal basis to process personal and
sensitive data. The legal basis for processing must be identified and documented before
the processing begins. In many cases we may need consent; this must be explicit,
informed, and documented. We cannot rely on opt out, it must be opt in.

Data Protection Act 2018 and General Data Protection Regulations 2016/679 is applicable
to all staff; this includes those working as contractors and providers of services.

For more information about your obligations under the Data Protection Act 2018 and
General Data Protection Regulations 2016/679 please see the Information Use Framework
Policy or contact the Information Governance Team

Royal Cornwall Hospital Trust [email protected]

2. The Guidance
2.1. Introduction

Procedural sedation is routine practice in the ED where patients may require

procedures that will cause pain and anxiety. Such procedures may be life or
limb-saving, and when performed in the ED can prevent patient admission.
Procedural sedation allows patients to tolerate otherwise painful or distressing
procedures by relieving anxiety and reducing pain. The drugs used during
procedural sedation have the potential to cause serious and life-threatening
complications. Standards for the safe sedation of patients in the ED allow
patients to benefit from procedural sedation and reduce the risk of
complications.

2.2. Definitions and Depth of Sedation

Sedation is a continuum ranging from normal level of level of consciousness to

complete unresponsiveness. The ASA defines four levels of sedation:

• Level 1 minimal sedation (anxiolysis) patients respond normally to

verbal commands. Cognitive function and co-ordination may be
impaired. Ventilatory and cardiovascular functions are unaffected. In the
ED this is achieved with inhaled nitrous oxide.

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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 • Level 2 moderate/ conscious sedation patients respond purposefully to
verbal commands either alone or accompanied by light tactile
simulation. Protective airway reflexes and adequate ventilation are
maintained without intervention. Cardiovascular function is usually
maintained. In the ED this is achieved with a combination of opioids and
benzodiazepines.

• Level 3 deep sedation the patient cannot be easily roused but responds
purposefully following repeated or painful stimulation. Assistance may
be needed to ensure the airway is protected and maintain adequate
ventilation. Cardiovascular function is usually maintained. In the ED this
is achieved with the combination of opioids and propofol.

• Level 4 general anaesthesia patients are not rousable, even by painful

stimulus. Require assistance to protect airway and maintain ventilation.
Cardiovascular function may be impaired.

• Dissociative sedation is a separate sedation category produced by

ketamine. Ketamine causes a trance like cataleptic state characterised
by profound analgesia and amnesia with retention of protective airway
reflexes, spontaneous respirations and cardiopulmonary stability. As
there is loss of verbal contact with patients during ketamine sedation
and because of the risk of significant (although rare) complications
ketamine sedation is grouped with deep sedation (level 3).

2.3. Scope

2.3.1. These guidelines apply to all staff who are involved with the care of
patients who require procedural sedation in the ED.

2.3.2. These guidelines apply to adult patients aged 16 years and over.

2.4. Responsibilities

2.4.1. Line managers are responsible for:

• Ensuring this document is disseminated to all appropriate staff

• Enabling staff to undertake required training and ensuring they

have achieved the required level of competency to deliver safe
sedation in the ED

• Taking active role in audit of sedation practice in the ED

2.4.2. Role of safe sedation in the ED group:

• Ensuring that RCHT guidance complies with national guidelines

on procedural sedation in the ED

• Ensuring dissemination of the guidance

• Encourages excellent clinical governance in the practice of

procedural sedation in the ED at RCHT

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 6 of 22
 • Takes an active role in the audit of sedation practice in the ED

2.4.3. Members of the clinical team

All staff members involved in procedural sedation in the ED are

responsible for:

• Ensuring they have read this guideline and refer to it when

performing procedural sedation in the ED

• Ensuring they are adequately trained to carry out their role in

sedation

• Ensuring the sedation proforma documentation is completed

2.5. Background

The standards for practice are based on the RCOA and RCEM documents and
recommendations for safe sedation in the ED.

2.6. Training Requirements and Personnel

2.6.1. Personnel

The minimum number of staff required for procedural sedation in the ED

is three:

• One doctor, advanced nurse practitioner (ANP) or emergency

nurse practitioner (ENP) who performs the procedure

• One doctor who performs the sedation

• One ED nurse responsible for monitoring the patient

2.6.2. Training Requirements

Training requirements for clinicians performing procedural sedation in

the ED are documented below:

2.6.2.1. Level 2 Moderate sedation using intravenous benzodiazepines and

opioids:

• Current ALS certification

• Local sign off for level 2 (moderate) sedation training

▪ Completed RCEM procedural sedation e-learning

module

▪ Performed minimum 5 supervised level 2 sedations.

The number of supervised procedures required to be
deemed competent will be at discretion of the
supervising ED consultant but is likely to a require a
minimum of 5 supervised procedures.

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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 ▪ Completion of sedation logbook (Appendix 3)

2.6.2.2. Level 3 Deep sedation using Propofol

• Current ALS certification

• Local sign off for level 3 (deep) sedation training

▪ Completed 6 months ICU/ anaesthetics

▪ Attendance at theatre sessions to maintain airway

skills. Recommended minimum requirement 1
theatre session per year

▪ Completed RCEM procedural sedation e-learning

module

▪ Perform 5 supervised procedural sedation cases

using Propofol. The number of supervised
procedures required to be deemed competent will be
a discretion of the supervising ED consultant but is
likely to a require a minimum of 5 supervised
procedures.

▪ Completion of sedation logbook (Appendix 3)

2.6.2.3. Dissociative sedation using Ketamine

• Current ALS certification

• Local sign off for level 3 (deep) sedation training

▪ Completed 6 months ICU/ anaesthetics

▪ Attendance at theatre sessions to maintain airway

skills. Recommended minimum requirement 1
theatre session per year

▪ Completed RCEM procedural sedation e-learning

module

▪ Performed 5 supervised procedural sedation cases

using Ketamine. The number of supervised
procedures required to be deemed competent will be
a discretion of the supervising ED consultant but is
likely to a require a minimum of 5 supervised
procedures.

▪ Completion of sedation logbook (Appendix 3)

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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 2.7. Environment, Equipment, Monitoring and Documentation

2.7.1. Location

2.7.1.1. Level 2 moderate sedation with intravenous benzodiazepines and

opioids can be performed in the theatre space in the minors area of
the ED. The availability of resuscitation equipment in this area must
be checked before performing sedation.

2.7.1.2. Level 3 deep sedation with propofol and dissociative sedation with
ketamine should only be performed in the resuscitation room.

2.8. Equipment

The following equipment must be available in the location where procedural

sedation is performed:

• Full resuscitation equipment for basic and advanced life support (resus/
crash trolley)

• Difficult airway equipment/ trolley for deep sedation in resus

• Continuous high flow oxygen with appropriate devices of administration

including non-rebreather masks, bag-valve-mask, Water’s circuit with
appropriately sized face masks

• High pressure suction with appropriate suction catheters and yankhuers

• Trolley capable of being tilted head down

• Monitoring equipment (see below)

• Appropriate range of intravenous cannula and intravenous fluids

• Reversal agent if available (Flumazenil should be available when

sedating with midazolam)

2.9. Monitoring

During procedural sedation all patients must have continuous monitoring

including:

• ECG

• NIBP

• Pulse oximetry

• End-tidal CO2 monitor

2.10. Documentation

The ED sedation pro-forma must be completed for all patients undergoing

procedural sedation (Appendix 4).

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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 2.11. Patient Selection

Contra-indications to ED procedural sedation:

• Allergy to required agent

• SpO2 < 92%/ PaO2 < 8Kpa air

• GCS < 14

• Active cardiovascular, respiratory or central nervous system disease

• Any ischaemic event (cardiovascular, neurological or peripheral

vascular) within 6 weeks

• History of difficult airway or airway surgery

• Abnormal facial anatomy

• Procedures involving posterior pharynx

• Head injury with loss of consciousness, reduced level of consciousness

or vomiting

• Central nervous system disease including masses, abnormalities,

hydrocephalus

• Psychosis, porphyria, thyroid disorder, thyroid medication

• Pregnancy

• Intoxicated with drugs or alcohol

• BMI > 35

2.12. Pre-Procedure Patient Assessment

All patients must have a pre-procedure assessment performed and documented

prior to procedural sedation. The pre-procedure assessment must include:

• Weight, BMI

• Full medical history including present medical history, indication for

procedure, past medical history, drug history, allergies, social history,
recreational drugs and alcohol

• Anaesthetic history including previous general anaesthetics and

sedations, complications during previous procedures, known airway
problems, dentition

• History of reflux

• Date and time of last food and oral fluid intake

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 10 of 22
 • Physical examination including vital signs and airway assessment

• ASA grade

2.13. ASA Grading

ASA grade must be recorded for all patients prior to sedation. Patient who are
ASA I and II, and selected III patients can be sedated in the ED. Patients who
are ASA IV and V should be discussed with senior anaesthetic colleagues.

ASA GRADES

ASA I Normal healthy patient

ASA II Mild systemic disease (well controlled asthma, COPD, diabetes,

hypertension (single agent treatment), angina (occasional GTN))
ASA III Moderate systemic disease examples poorly controlled asthma,
COPD, diabetes, hypertension (multiple agents), angina (regular use
of GTN)

ASA IV Severe systemic disease

ASA V Moribund

2.14. Airway Assessment

2.14.1. All patients must have an airway assessment to identify features

associated with difficulty in airway management.

2.14.2. History of features associated with difficult airways should be

documented:

• Previous problems with anaesthetics or sedation

• History of sleep apnoea or stridor

• Severe arthritis limiting neck mobility or laxity (Downs

syndrome), reflux

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 11 of 22
 2.14.3. Physical examination to identify features of difficult airway using the
LEMON mnemonic:

LEMON Airway Assessment Tool

Look externally for features associated with difficult airways including

L obesity, beards facial trauma, large incisors, large tongue, micrognathia
E Evaluate the 3-3-2 rule
• Mouth opening 3 finger breadths

• Hyoid-chin distance 3 finger breadths

• Thyroid cartilage to mouth floor distance 2 finger breadth

LEMON Airway Assessment Tool

M Mallampati score: patients with Mallampati score 1 or 2 can be sedated in

the ED. Patients with Mallampati scores of 3 or 4 should not be sedated
in the ED without discussion with a senior anaesthetist.

O Is there any evidence of, or potential airway obstruction? Presence of

epiglottis, peritonsillar abscess, tumour, trauma, tracheostomy scar

N Is neck mobility limited or unstable due to injury, immobilisation or pre-

existing disease (severe rheumatoid arthritis, Downs syndrome)

2.14.4. Patients with features of a difficult airway should not be

sedated in the ED without discussion with a senior
anaesthetist.

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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 2.15. Fasting

2.15.1. The RCEM current recommendation is that procedural sedation in

the ED should not be delayed in adults based on fasting time as
there is no demonstrated reduction in risk of vomiting or aspiration.
The risk of aspiration should be discussed with patients when
possible. Deep sedation should only be performed in non-fasted
patients for emergency procedures.

2.15.2. For elective procedures the fasting rule used for general
anaesthesia (2 hours for clear fluids and six hours for solids) should
be used.

2.16. Drug Selection

2.16.1. Analgesic Agents

MORPHINE

Route IV

Initial dose 0.1mg/kg IV titrated to effect

Onset 5 – 10 mins

Peak effect 10 – 15 mins

Adverse effects Respiratory depression, hypotension, nausea/ vomiting, pruritus

Antagonist Naloxone 400 micrograms IV if no response after 1 minute give

800 micrograms, if no response give 2mg then review (this higher
dose regimen should not be used in patients with opioid misuse
and dependence due to risk of acute withdrawal) (BNF)

FENTANYL

Route IV

Initial dose 0.5mcg/kg

Repeat dose 0.5mcg/kg every 2 mins

Onset 1 – 2 mins (longer in the elderly)

Peak effect 3 – 5 mins

Adverse effects Respiratory depression, hypotension, nausea/ vomiting, pruritus

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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 2.16.2. Sedating agents

MIDAZOLAM

Role Sedation/ amnesia

Level 2 Moderate sedation

Route IV (over 1 – 2 mins)

Initial dose Adult 1 – 2mg (max. single Elderly 0.5mg

dose 2.5mg)

Repeat dose After 2 – 5 mins (reduce dose frequency in the elderly)

Initial onset time 1 – 2 mins (longer in the elderly)

Peak effect time 3 – 4 mins

Adverse effects Respiratory depression, hypotension, poor sedative, risk of

prolonged sedation (in particularly in the elderly, obese and
patients with hepatic or renal disease), unpredictable action

Antagonist Flumazenil IV 20 micrograms/kg

PROPOFOL

Role Sedation/ amnesia

Level 3 Deep sedation

Route IV

Initial dose Adult 0.5 – 1.0mg/kg (lean Elderly 10 – 20mg given

body mass) slowly

Repeat dose Adult 0.5mg/kg every 3-5mins Elderly 10 – 20mg given

slowly

Initial onset time ½ - 1 min (often longer in the elderly)

Peak effect time 1 – 2 mins

Adverse effects Respiratory depression, hypotension, pain at site of injection

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 14 of 22
 KETAMINE

Role Sedation/ amnesia/ analgesia

Dissociative sedation

Route* IV give over 30 – 60 seconds

Initial dose Adult 1mg/kg titrated to effect Elderly 10 – 30mg

over 60 seconds

Repeat dose 0.25 – 0.5mg/kg every 5 – 10mins

Initial onset time ½ - 1 min

Peak effect time 1 – 2 mins

Adverse effects Increased secretions, laryngospasm, vomiting, tachycardia,

hypertension, increased intracranial and intraocular pressure.
Emergence phenomenon – consider pre-treating adult patients
with 1 – 2 mg midazolam to prevent emergence phenomenon

Specific Absolute contraindication schizophrenia

Contraindications
Relative contraindications active respiratory disease or
infection (including URTI), cardiovascular disease including
angina, hypertension, heart failure, CNS masses/
abnormalities/ hydrocephalus, globe injury, glaucoma

*IM Ketamine

Should only be used in adults with learning difficulties or behaviour problems. Initial
dose 4 – 5mg/kg and repeat dose 2 – 2.5mg/kg every 5 – 10 mins.

2.17. Consent

Informed consent must be obtained and documented. Consent must include:

• Details of the procedure including type and duration of sedation

• Indications for the procedure

• Potential risks of the procedure

• Potential for failure

• Alternatives

• Review of discharge criteria

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 15 of 22
 2.18. During the Procedure

2.18.1. The pre-procedure safety checklist should be used prior to starting

sedation.

2.18.2. Monitoring

During procedural sedation all patients should have continuous

monitoring including ECG, NIBP, pulse oximetry and end-tidal CO2.

2.18.3. Oxygen

During procedural sedation all patients should have oxygen at 15

L/minute via a non-rebreather mask.

2.18.4. Documentation

2.18.4.1. Patient observations should be documented every 5 minutes.

2.18.4.2. The level of sedation should be monitored and documented

according to the ASA classifications.

2.18.4.3. Any sedation adverse events must be documented on the

sedation pro-forma.

2.19. Recovery and Discharge

2.19.1. Post procedure monitoring should continue in the same clinical area
until the level of consciousness and vital signs have returned to pre-
procedure levels. Patient should be monitored for 30 minutes from
the last dose of sedative agent.

2.19.2. Patients can be discharged when the following discharge criteria are
meet:

• Vital signs stable and within normal limits for the patient

• Pain addressed

• Nausea and vomiting addressed

2.19.3. All patients discharged home must be in the care of a responsible

adult and discharged with written and verbal advice (Appendix 5).

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 16 of 22
3. Monitoring compliance and effectiveness
Information
Detail of process and methodology for monitoring compliance
Category
Element to be Adverse events during procedural sedation
monitored
ED sedation lead Dr Bareham and Dr Shekdar ED clinical
Lead governance lead

Periodic ED audit of procedural sedation

Tool
Serious adverse events reported using Datix
Within 6 months of guideline publication
Frequency
As serious adverse events occur)
Reporting Report to the ED sedation lead
arrangements
Acting on
Required changes to practice will be identified and actioned in as
recommendations
rapid timeframe as possible
and Lead(s)
Required changes to practice will be identified and actioned. A
Change in practice
senior member of the ED team will be identified to take each
and lessons to be
change forward where appropriate. Lessons will be shared with all
shared
the relevant stakeholders

4. Equality and Diversity

4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service
Equality and Diversity statement which can be found in the 'Equality, Inclusion &
Human Rights Policy' or the Equality and Diversity website.

4.2. Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 17 of 22
Appendix 1. Governance Information

Information Category Detailed Information

Procedural Sedation of Adult Patients in the

Document Title:
Emergency Department Clinical Guideline V2.0
This document replaces (exact Procedural Sedation of Adult Patients in the
title of previous version): Emergency Department Clinical Guideline V1.1

Date Issued/Approved: February 2022

Date Valid From: February 2022

Date Valid To: February 2025

Directorate / Department
J Bareham, ED Consultant
responsible (author/owner):

Contact details: 01872 252452

The purpose of this guideline is to improve patient

safety and quality of care by setting standards for
Brief summary of contents: the safe sedation of adult patients in the ED. The
guideline sets training standards and requirements
for ED clinicians delivering sedation.
Suggested Keywords: Sedation, Emergency Department.
RCHT: Yes
Target Audience: CFT: No
KCCG: No
Executive Director responsible
Medical Director
for Policy:
Emergency Department Governance Group
Approval route for consultation
Urgent, Emergency and Trauma Governance
and ratification:
Group

General Manager confirming

Jo Floyd
approval processes:

Name of Governance Lead

confirming approval by
Paul Evangelista
specialty and care group
management meetings:
Links to key external standards: None required

Related Documents: The Royal College of Anaesthetists and The

College of Emergency Medicine Working Party on

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 18 of 22
 Information Category Detailed Information

Sedation Anaesthesia and Airway Management in

the ED. Safe Sedation of Adults in the ED.
November 2012
The Royal College of Emergency Medicine Best
Practice Guidelines, Pharmacological Agents for
Procedural Sedation and Analgesia in the ED. May
2016
American College of Emergency Physicians.
Procedural Sedation and Analgesia in the ED.
October 2013
Training Need Identified? See section 6.2.1.
Publication Location (refer to
Policy on Policies – Approvals Internet & Intranet
and Ratification):
Document Library Folder/Sub
Clinical / Emergency Department
Folder:

Version Control Table

Version
Date Summary of Changes Changes Made by
Number
Dr J Bareham – ED
April 2019 V1.0 Initial issue
Consultant
February Dr J Bareham – ED
V1.1 Changes to the Care Group name
2022 Consultant

All or part of this document can be released under the Freedom of Information Act
2000

This document is to be retained for 10 years from the date of expiry.

This document is only valid on the day of printing

Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 19 of 22
Appendix 2. Equality Impact Assessment

Section 1: Equality Impact Assessment (EIA) Form

The EIA process allows the Trust to identify where a policy or service may have a negative
impact on an individual or particular group of people.

For guidance please refer to the Equality Impact Assessment Policy (available from the
document library) or contact the Equality, Diversity & Inclusion Team [email protected]

Information Category Detailed Information

Name of the strategy / policy / proposal / Procedural Sedation of Adult Patients in the
service function to be assessed: Emergency Department Clinical Guideline
V2.0
Urgent, Emergency and Eldercare Medicine/
Directorate and service area:
Emergency Department
Is this a new or existing Policy? Existing
Name of individual completing EIA Dr J Bareham, ED Consultant
(Should be completed by an individual with
a good understanding of the Service/Policy):
Contact details: 01872 252452

Information Category Detailed Information

1. Policy Aim - Who is the
Policy aimed at?
(The Policy is the To promote the practice of safe sedation of adults in the
Strategy, Policy, Proposal emergency department
or Service Change to be
assessed)

To identify standards required for safe procedural sedation in

2. Policy Objectives
the emergency department.
To improve patient safety and quality of care by setting
3. Policy Intended standards for the safe sedation of adult patients in the
Outcomes emergency department.

To identify training standards and requirements for

emergency department clinicians delivering sedation.
4. How will you measure Audit process
each outcome? Investigation of serious adverse events

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

Page 20 of 22
Information Category Detailed Information
All patients aged 16 years and older who require procedural
sedation in the emergency department at RCHT.
5. Who is intended to
All staff involved in procedural sedation in the emergency
benefit from the policy?
department will be aware of the standards expected of their
practice

• Workforce: Yes
6a. Who did you consult • Patients/ visitors: No
with?
• Local groups/ system partners: No
(Please select Yes or No
for each category) • External organisations: No
• Other: No
6b. Please list the
individuals/groups who
Representatives in ED and Anaesthetics
have been consulted
about this policy.
6c. What was the outcome
Ratified
of the consultation?
6d. Have you used any of
the following to assist No
your assessment?

7. The Impact

Following consultation with key groups, has a negative impact been identified for any
protected characteristic? Please note that a rationale is required for each one.

Where a negative impact is identified without rationale, the key groups will need to be
consulted again.

Protected Characteristic (Yes or No) Rationale

Additional consideration for elderly patients

Age No
when performing procedural sedation

Sex (male or female) No

Gender reassignment
(Transgender, non-binary, No
gender fluid etc.)

Race No

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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Protected Characteristic (Yes or No) Rationale

Disability (e.g. physical or

Considering mental capacity act and
cognitive impairment, mental
No consent issues, consider associated health
health, long term conditions
conditions
etc.)

Religion or belief No

Marriage and civil

No
partnership

Additional consideration for pregnant

Pregnancy and maternity No patients when performing procedural
sedation

Sexual orientation (e.g. gay,

No
straight, bisexual, lesbian etc.)

A robust rationale must be in place for all protected characteristics. If a negative

impact has been identified, please complete section 2. If no negative impact has been
identified and if this is not a major service change, you can end the assessment here.

I am confident that section 2 of this EIA does not need completing as there are no
highlighted risks of negative impact occurring because of this policy.

Name of person confirming result of initial impact assessment: Dr J Bareham

If a negative impact has been identified above OR this is a major service change,
you will need to complete section 2 of the EIA form available here:
Section 2. Full Equality Analysis

Procedural Sedation of Adult Patients in the Emergency Department (ED) Clinical Guideline V1.1

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