Procedural Sedation and Analgesia in the Emergency Department

Patients present to the emergency department (ED) for a variety of reasons and some require diagnostic and therapeutic procedures for their conditions. In order for some of these procedures to be carried out successfully, the patient must be at a suppressed level of consciousness in order to tolerate the associated pain and anxiety. Medications administered to achieve these goals include analgesics and sedatives as they decrease the patient's discomfort and awareness while allowing the patient to maintain their airway. However, medication selection and dosing is critical and should be tailored to each patient and procedure. Pharmacists have an opportunity to reduce medication errors during procedural sedation and analgesia (PSAA) as the majority of medication errors leading to adverse events occur during the ordering and administration steps of the medication use process. Common errors include drug-dosing, potential drug interactions, and administration of the wrong pharmacologic agent. Pharmacists in the ED can provide drug information and assist with drug selection and dosing; medication preparation; and monitoring of the patient and of the time intervals since medication administration relative to the duration of the procedure. Having a pharmacist present provides an extra layer of protection and reduces the likelihood for potential medication errors.