McCoy Siobhán, Wakai Abel, Blackburn Carol, Barrett Michael, Murphy Adrian, Brenner Maria, Larkin Philip, Crispino-O'Connell Gloria, Ratnapalan Savithiri, O'Sullivan Ronan
Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
Syst Rev. 2013 Oct 1;2:89. doi: 10.1186/2046-4053-2-89.
The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates.
METHODS/DESIGN: Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed.
This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes.
PROSPERO registration number: CRD42013003851.
在医院环境中，手术室以外使用程序性镇静的情况有所增加，并且在非麻醉医生中越来越普遍。用于程序性疼痛的镇静剂虽然有效，但如果使用不当也会给患者带来重大风险。目前，对于在实践中使用或引入程序性镇静的从业者，尚无普遍接受的教育计划。有新出现的文献将结构化程序性镇静计划（PSP）视为确保工作人员具备标准化能力水平并降低患者风险的一种方法。我们假设，针对在手术室以外使用程序性镇静的医疗保健专业人员的教育计划，有助于改善患者护理、安全性、从业者能力并降低不良事件发生率。
方法/设计：将系统检索电子数据库，查找1966年至今检验结构化PSP有效性的研究（随机和非随机）。通过与专家联系、参考文献和引文检查以及灰色文献检索来补充数据库搜索。不设语言限制。由两名独立评审员进行标题和摘要筛选以及数据提取。所有分歧将通过与独立第三方讨论来解决。数据分析将按照《Cochrane干预措施系统评价手册》中概述的程序完成。如果数据允许，将进行荟萃分析。
本综述将整合关于结构化PSP在医院及其他急性护理环境中对镇静事件和患者结局有效性的证据。此外，它将研究PSP中与患者安全和改善患者结局相关的关键组成部分。
PROSPERO注册号：CRD42013003851。
