Sedation Issues:  Ativan and Versed

Sedation Issues: Ativan and Versed

Since January 1, 2017, there have been numerous instances in which providers have not followed the proper protocol when it comes to the proper medication, dose or route involving Ativan and Versed.  The old and new protocols were taken into account and these issues were outside of both scopes.

Is it possible that the issues are strictly a documentation issue?  Yes.  Maybe the wrong dose or route was listed but the medication was given properly.  Maybe it was given with a physician order and labeled as standing. This isn’t an Elite issue. The problem is that the report does not indicate anything but what is listed so that is all that we have to go by.

Please remember that any patient receiving Ativan, Versed, Morphine, Fentanyl, Etomidate, or Haldol must have the EKG and pulse oximetry/end tidal applied as well as closely monitored for respiratory depression or other reactions.

Please ensure that you review each protocol. We should all be under the new protocols now.

https://tidewater.vaems.org/docman/protocols/2016-tems-protocols/2154-2017-03-08-tidewater-ems-regional-medical-protocols-pocket-guide

Here are some very brief summaries of our current protocols:

Breathing Difficulty (CPAP): consider 1 mg Ativan (Will verify route as none is listed.  Presuming IV).

Seizure: Ativan 2mg IV/IM or Versed 5 mg IN  may repeat once

Combative Patient: If medicating-Versed 5mg IN or Versed 2mg IV or Versed 10mg IM

  • If Versed is administered, Haldol 10mg IM or Haldol 5mg IV

Airway (post intubation sedation): Versed 2-2.5mg IV

Post RSI: Versed 5 mg IV, may repeat once

Bradycardia/Tachycardia (pacing/cardioversion):consider Versed 2mg IV/IO/IM/IN

If a discussion with medical control leads to a deviation from the listed protocols, it needs to be clearly documented (physician order for meds, alternative dosing, etc).  Every patient and situation is different so you are encouraged to think.  We just need to confirm this with medical control and properly document the situation and all the factors.  The protocols indicate when something can be repeated up to the maximum dose listed.  If there is no specific “repeat” dose/note, you will need medical control to approve the order.

We will be monitoring the situation over the next few months very closely.  If you have any questions, please consult your protocols, a supervisor, myself or training.

Waste note:  If you are not administering an entire vial of the medication (either drawn up or some is left in the vial), you should be completing the Controlled Substances section.  If you administer the entire vial to the patient, you do not need to complete the section since no medication was disposed of/wasted.