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reaching the patient. This may be related to the lack of a pharmacist’s
involvement in most ED decisions.
The Joint Commission advocates a “time-out” before any medication is
given to verify the correct patient, site, and medications. Anticipate
complications such as laryngospasm or vomiting. Have a backup plan for
complications before they arise. The Joint Commission emphasizes the
concept of “sedation rescue,” which is essential to safe sedation. The ability
to rescue a patient after an adverse event is also emphasized by AAP
guidelines.

Documentation
Careful documentation of the use of sedatives and analgesics is important. If
an inpatient or outpatient record already exists, there is no need to repeat the
information previously documented. However, a brief note is recommended
to indicate that the chart was reviewed before giving sedative agents. A note
indicating the child’s presedation status is helpful and there should be a
notation that the patient’s condition has not changed since arrival or since the
last examination in the record.
When using sedatives and analgesics, a well-designed, time-based record
is essential. The use of a separate form or checklist is particularly useful as a
supplement to the ED note. The checklist may improve efficiency and may
serve to remind the caregiver to ask specific questions or perform a specific
part of the physical examination. The record should indicate any history of
allergies or adverse drug reactions, as well as medications used prior to
sedation. It is wise to place this information near the section for writing the
sedation orders so they can be reviewed when medications are ordered.
The physical examination should focus on the airway and cardiovascular
system. It is also helpful to document the child’s level of consciousness
during the procedure (e.g., how he or she responds to verbal commands or
tactile stimulation). Note the patient’s level of consciousness again prior to
discharge.

Discharge instructions must be reviewed with the child’s guardian before
the patient is allowed to go home. They should include a reminder to parents
that the child should not be involved in activities that require coordination,
such as bicycle riding or skating, for perhaps 24 hours. Adult supervision
should be recommended for at least 8 hours. Unsupervised bathing and use