Các JCAHO cũng duy trì một chính sách về an toàn bệnh nhân và các phản ứng thể chế sự kiện trọng điểm. Những sự kiện này được định nghĩa là: bất ngờ xảy ra [s] liên quan đến tử vong hoặc nghiêm trọng về thể chất hoặc tâm lý chấn th | Sedated Patients Nursing Perspectives 253 Maintaining a depth of sedation that promotes the patient s comfort while maintaining responsiveness can be challenging. Titration of short-acting iv agents throughout the procedure may be the best method to produce this level of sedation. The advantage of this method is that the desired effect can be achieved while avoiding unwanted side effects associated with higher bolus doses of medication 40 . It is important that such titration be done carefully and with patience. Small doses of medication should be administered at intervals that allow the peak effect of the previous bolus to be assessed 5 . Bolus doses that are administered too closely together may produce a deeper than intended level of sedation with associated increased risks. When non-parenteral routes are used to administer medications the time required for drug absorption should be considered prior to supplementation with additional medications. When deep sedation is required to complete the procedure a larger bolus of medication prior to the procedure is generally warranted. However maintaining deep sedation during long procedures or for those that are painful or stimulating frequently requires augmentation of sedation with additional doses of sedatives or analgesics. For painful procedures adding a short-acting opioid such as fentanyl provides analgesia as well as adjunctive sedation. For nonpainful procedures a short-acting benzodiazepine or barbiturate can effectively supplement sedation in many patients. With any combination of medications used it is important to consider the potential for increased risks for prolonged sedation or synergistic respiratory depression 41 . Augmenting sedation with a drug that can be reversed may therefore be in the best interest of the patient. Occasionally the sedative agent s fail to produce a depth of sedation that is necessary to complete the procedure. The incidence of failed sedation in children has been reported to be
