Best Practice, Mercy Medical Center

Best Practice: Implementation of a comprehensive Procedural Sedation Program for Interventional Radiology and Catheterization Lab nurses through shared governancesmlaura, Best Practice, Mercy Medical Center, Baltimore, MD

Kim Dorsey, BSN, RN, CCRN, CLIN IV, a staff nurse on the Interventional Radiology unit and the Cardiac Catheterization lab for the past 31 years at Mercy Medical Center, Baltimore, MD, is and has been involved in the divisional and unit-based Practice Council for most of her working years, having been chair in the past. She is an active member of her unit-based shared governance council as well.

A well-established, robust shared governance team thrives in the Interventional Radiology and Cath Lab areas. The interprofessional team includes nurses, some of whom are division council representatives; radiology staff; and often the medical director. Monthly meetings are held to discuss departmental issues and develop solutions addressing those concerns. The meeting agenda is built on our professional practice model and during a discussion about care delivery, a nurse voiced concern about the varying degrees of comfort levels in nurses with administering procedural sedation. Some nurses did not feel confident in sedating higher-acuity patients, even though they were qualified to give sedation and the patients were stable enough to receive it.  Additional discussion with the physicians revealed they, too, were experiencing differences in comfort levels among the nurses. These disparities were also thought to be contributing to lower nurse-to-physician interaction satisfaction scores. We knew we had a problem, so through the shared governance process, we worked to implement a solution.

Shared governance allows for the authority in decision-making to have an impact on practice. Our team felt we needed a more comprehensive education program to ensure competency and confidence in administering procedural sedation. What we really wanted to know was would there be a difference in perceived importance, confidence, competence, and satisfaction following a structured sedation education program?

A subgroup of our shared governance committee started with a literature search. The findings showed that while evidence and practice standards from the American Nurses Association, the American Society of Anesthesiologists, and the the Association for Radiologic & Imaging Nursing  spoke to the need for competence in sedation pharmacology and airway management, there was no clear definition of what constituted adequate education to positively impact the nurse’s confidence levels. Since there was an evidence gap, our shared governance subgroup worked with our nurse researcher and developed a research question as well as an institutional review board protocol.

The subgroup recommended two interventions, which were supported by our shared governance committee. Because of financial implications, nursing administration allocated funds to support this initiative The first component was to complete the Certified Sedation Registered Nurse program. This certification was a 10-hour course that included a pretest, online modules, and a post-test. Once certification was completed, each nurse was paired with a certified registered nurse anesthetist or anesthesiologist for a hands-on practicum in airway management.

Our results were impressive. The research study included a validated pre- and post-survey evaluating knowledge, confidence, competence, and satisfaction. Through collaboration with the hospital statistician, data analysis evaluating the research demonstrated a statistically significant change in mean scores (using a p-value ≤ 0.05) after completion of the program.

The autonomy of our shared governance allowed our unit to change and improve our sedating protocols, positively impacting our nurses’ confidence and competence with procedural sedation. This impact has also improved our communication and relationships with our physicians. This improvement has also enhanced the working environment, which was reflected by improvements in nurse-to-physician interaction satisfaction scores that continue to be above the benchmark.

When a hospital supports shared governance, it allows everyone to come together, take control of an issue, participate in solving the problem, and show improvement with the solution by practices changes that ultimately improve patient outcomes.  It is amazing what the power of shared governance in nursing can achieve.