Inova Fairfax Hospital/Inova Fairfax Hospital for Children - Neurodiagnostic Laboratory

Medication Administration to Patients in the Neurodiagnostic Laboratory

Revised: February 2002

______Anne M. Lohr, Manager Barbara Mancini, Patient Care Director Neurodiagnostic Laboratory Neuroscience Services

______James P. Simsarian, MD, Medical Director Lorna Facteau, RN, DNSc. Neurodiagnostic Laboratory Director, Children’s Services

PURPOSE:

To promote safe and consistent care for the patient undergoing Neurodiagnostic Laboratory diagnostic procedures (EEG, Evoked Potential and/or hearing screening); to safely monitor and administer medication to patients requiring Anxiolysis in the Neurodiagnostic Laboratory at Inova Fairfax Hospital/Inova Fairfax Hospital for Children. Definition: Anxiolysis: A drug- induced state during which patients respond to verbal commands although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected. Procedures may be attempted without Anxiolysis.

POLICY STATEMENT: The administration of Anxiolysis by non-anesthesia personnel for diagnostic non-invasive procedures in the Neurodiagnostic Laboratory of Inova Fairfax Hospital/Inova Fairfax Hospital for Children will be practiced in accordance with the following policy.

INTENT: This policy is intended to outline use of Anxiolysis for patients of any age (neonate through geriatric) and does not pertain to patients receiving agents that produce moderate or deep sedation. If there are questions regarding the patient status or the patient progresses to a moderately sedated level, the Department of Anesthesia will be notified and the Inova Health System Sedation policy will be implemented.

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SCOPE: This policy addresses Anxiolysis for procedures managed by Neurodiagnostic Laboratory Technologists. This policy does not apply to any patient with moderate or deep sedation. Technologists will complete the unit specific competency “Inova Fairfax Hospital/Inova Fairfax Hospital for Children Competency for Technologists Administering Anxiolysis in the Neurodiagnostic Laboratory” regarding dose calculation, measuring dose, and pulse oximeter usage on an annual basis or as required by the laboratory Manager. Additionally, technologists will maintain CPR Certification for all age groups.

POLICY:

1. A. A single anxiolytic dose may be given as follows:

1. Neonates may be given oral Chloral Hydrate <25 mg/kg.

2. All infants/toddlers and children weighing <35 kilograms may be given oral Chloral hydrate <25 mg/kg.

B. All patients weighing >35 kilograms may be given 250 mg oral Chloral Hydrate. This dosage may be repeated twice in 30 minute intervals as needed (maximum dose = 750 mg).

C. The Neurodiagnostic Laboratory technical staff will administer oral Anxiolysis to outpatients scheduled for EEG's and Evoked Potentials when needed. Physician authorization for administering the medication to outpatients must be written and signed on a prescription form, including the name of the procedure and the drug to be administered.

1. All outpatients 16 years of age or older who are given Anxiolysis (Chloral Hydrate) will be required to sign a statement prior to the administration of the medication stating that he/she will not operate a motor vehicle on the date on which medication is administered.

D. Nursing staff will administer oral Anxiolysis to pediatric and adult inpatients scheduled for EEG’s and Evoked Potentials when needed only if the referring physician writes an order in the patient chart, specifying Anxiolysis Chloral Hydrate, route and whether repeat doses are authorized.

E. Adult patients scheduled for T1/T1 and/or sleep deprived EEG's may be given up to 250 mg of oral Chloral Hydrate 30-60 minutes prior to the test when ordered by the physician. This dosage may be repeated twice in 30 minute intervals (maximum dose = 750 mg) by the Neurodiagnostic Laboratory staff if necessary when ordered by the attending physician.

Medication Administration to Patients MED-1 Page 2 of 4 F. All patients who receive Chloral Hydrate Anxiolysis for a procedure in the Neurodiagnostic Laboratory will be monitored by a continuous pulse oximeter.

G. Floor stock Chloral Hydrate will be maintained in the designated secure locked cabinet in the Neurodiagnostic Laboratory.

PROCEDURE:

1. Obtain a written order for the medication from a doctor licensed and credentialed to prescribe C-IV’s/Chloral Hydrate.

2. Verify the correct dosage of Chloral Hydrate according to the policy above.

3. Verify the correct patient to receive the medication.

4. Verify that outpatients will not be operating a motor vehicle the remainder of the day for the date the Anxiolysis is given, and that a statement to that effect has been signed by the patient.

5. Verify pregnancy status prior to administering Chloral Hydrate to females of child bearing age. If patient is or may be pregnant, do not administer any medications.

6. The on-call staff person will order floor stock Chloral Hydrate from the Pharmacy as needed (refer to Department of Pharmacy Services policy 3.1.1 on form #804041/R9-96).

7. Verify that the following contraindication do not exist. If any of the below listed contraindications doexist, the Neurodiagnostic Laboratory technical staff must obtain written permission from the patient’s primary specialist (if sedation is required): - apnea/respiratory problems/severe reflux - cardiac problems - liver disease

8. Pre-procedure information to be obtained and documented from the patient, parent or legal guardian by the trained Neurodiagnostic Laboratory staff member will include: -baseline vital signs (including pulse oximeter reading) -baseline mental status -allergies -current medication information -medical history -eating restrictions - liquids only

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9. The following equipment will be available and in working order: -suction set up -age and size appropriate airway equipment -age and size appropriate intravenous equipment -continuous pulse oximetry monitor (with alarms turned on) -oxygen delivery system -age and size appropriate ambu bag

10. Double-check the dosage, patient and medication; Administer the medication as ordered.

11. Document the date, patient name, drug dose, amount wasted (co-signed by technologist witnessing waste), name of person administering medication, and physician ordering medication on appropriate medication sign out sheet.

12. Enter the medication charge into Phamis/Last Word.

13. Throughout the procedure monitor and document continuous oxygen saturation, heart rate and level of consciousness on the appropriate flow sheet every l0 minutes. Visual observation will also be continuous.

14. Prior to discharge of outpatients, the patient must be awake, have the ability to maintain airway, move purposefully as appropriate for age, breathe deeply/cough, have satisfactory color; respond to verbal commands appropriately, and move all extremities. This information will be documented on the appropriate flow sheet.

15. Complete the written discharge instruction sheet (see appendix A/English; appendix B/Spanish); give one copy to the patient/parent/guardian and verbally review the instructions with the appropriate person. A second written copy will be sent to Medical Records for filing in the patient record. Ask if there are any questions. Refer them to their referring physician for concerns that occur after leaving the hospital.

16. If inpatient, the nurse receiving the patient after completion of the study shall receive a full report including any complications or unusual responses to treatment.

17. If any outpatient procedure is performed without Chloral Hydrate it should be documented on the procedure report that no sedation was used.

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