The Joint Commission: Sedation and Anesthesia Assessments

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Introduction

• TJC is an independent, not-for-profit organization that accredits and certifies more than 22,000 health care organizations and programs in the United States.
• According to their website (Link), the mission of TJC is to “continuously improve healthcare for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”¹
• This summary will focus on the assessment and rescue requirements for sedation and general anesthesia.

Presedation or Preanesthesia Assessment²

• TJC does not dictate the content of the preassessment. This should be based on established or recommended professional practices (e.g., American Society of Anesthesiologists, American Association of Nurse Anesthetists, American Dental Association)
• Moderate sedation – the qualification to perform moderate sedation is determined by the organization and not TJC. This should be consistent with organizational and state rules and scope of practice.
• Deep sedation/regional blocks/general anesthesia – the assessment must be performed by an anesthesia provider or licensed practitioner with appropriate privileging in accordance with hospital policies and state scope of practice laws.

Immediate Presedation, Preanesthesia Evaluation²

• Re-evaluation must occur immediately prior to the initiation of moderate sedation, deep sedation, or general anesthesia. The organization/hospital determines the required elements and documentation. This is typically the first entry on the procedure or anesthesia record.
• Moderate sedation – the organization may determine who can perform this assessment based on staff competencies and state scope of practice laws and regulations.
• Deep sedation/regional blocks/general anesthesia – the assessment must be performed by a qualified individual consistent with state laws and regulations.

Postanesthesia Assessment²

• Postanesthesia assessments for both inpatients and outpatients must be completed by an anesthesia provider or appropriately credentialled licensed practitioner within 48 hours of movement from the operative/procedure area to the recovery area. This assessment may not be delegated.
• The assessment should not be performed immediately after the patient is moved to the recovery area and should not begin until the patient has sufficiently recovered from the sedation or general anesthesia (able to answer questions, perform simple tasks, etc.).
• Components of the assessment may include, but are not limited to, respiratory function, including respiratory rate, airway patency, and oxygen saturation; cardiovascular function, including pulse rate and blood pressure; mental status; temperature; presence of nausea and/or vomiting; pain and postoperative hydration.

Discharge Assessment²

• A licensed practitioner completes discharge assessments, or the patient may be discharged upon order from a licensed practitioner based on criteria established by the organization’s medical staff.

Rescue Requirements³

• The individual who administers moderate or deep sedation must also be competent to perform the rescues required by the sedation and anesthesia standards. The availability of an on-demand code team is not sufficient.