Nurse-Administered Sedation Safe and Effective in Area with Few Resources
Nurses in a rural African emergency department who were given a brief training in procedural sedation using ketamine had success rates of 100 percent and an adverse event rate similar to that reported in higher-income settings. The first published report of its kind was published online Friday in Annals of Emergency Medicine (“Nurse-Administered Ketamine Sedation in an Emergency Department in Rural Uganda”) http://bit.ly/rYHXOG.
“Patients undergoing painful procedures in low-income, rural areas can have greater access to analgesia and sedation through this program,” said Dr. Bisanzo. “The alternatives – painful procedures being performed with inadequate pain control, being delayed or not being performed at all – lead to suffering, complications and poor outcomes that would be unacceptable in a more developed healthcare system.”
Six nurses with no previous sedation experience were trained in procedural sedation using ketamine. The trained nurses administered procedural sedation 191 times to 118 different patients. Adequate sedation was achieved in 100 percent of patients. There was an 18 percent adverse event rate and all adverse events were minor. Patient satisfaction was high: 98 percent reported they would want ketamine for a future procedure.
The training was given at Karoli Lwanga Hospital, which opened Uganda’s first rural emergency department in 2008. The hospital is located in a district with only one physician for every 18,500 people. By contrast, that area has one nurse for every 895 people.
“In countries where nurses greatly outnumber doctors, nurse-administered ketamine can increase access to appropriate and safe sedation,” said lead study author Mark Bisanzo, MD, DTM&H of the University of Massachusetts Memorial Medical Center in Worcester, Mass. “Low-income countries tend to have physician shortages, especially in rural areas. This is one way to reduce the consequent delays in care and even death.”
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.