PB14 Audit of procedural sedation in the Emergency Department of Wishaw General Hospital
Bibliographic record
Abstract
Objectives and Background Sedation is a commonly performed procedure with a number of significant consequences should it go wrong. The Working Party chaired by Royal College of Anaesthetists, Canadian Consensus Guidelines and the American College of Emergency Physicians have all published guidelines detailing the minimum standards required for safe sedation. These cover the topics of patient assessment, general facilities, sedation procedure and post-sedation care. Our aims were twofold: to determine if sedation was being carried out safely and whether documentation was thorough. Methods Thirty eight notes from August 2010 to February 2011 were retrospectively reviewed. These were identified by searching the department database for diagnoses of “dislocation” and “radial fracture”, then cross-referencing with patients who received midazolam (recorded in the controlled drugs register). Children were excluded. The data collected was compared against aforementioned published guidelines. Results There was no recorded assistant in 25/38 (66%) of cases. Drug doses were not recorded in 14/38 (37%) and in 7/38 (18%) there was no prescription. Physiological monitoring was documented in only 11/38 (29%) of cases. Fasting status was recorded in 6/38 (16%) of cases. Of patients discharged home 24/38 (63%), there was no documentation of follow-up in 15/24 (62.5%). The notes were recorded by the following staff: junior 19/38 (50%), middle grade 11/38 (29%), Consultant 5/38 (13%) and other 3/38 (8%). Conclusions Documentation is falling short of achieving the expected standards. Essential aspects of safe sedation are not being carried out. All ED doctors now have to attend a short workshop on safe sedation prior to carrying out any procedures requiring sedation. A sedation form is being introduced for recording and monitoring purposes. We have organised a re-audit starting in September to see if our changes have improved practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".