Nurses gave patients anaesthetic drugs against guidelines at The Canberra Hospital.

By Simon Hendel.

Nurses at The Canberra Hospital have been administering powerful anaesthetic drugs during endoscopies for more than a decade without the supervision of suitably qualified doctors, in contravention of the College of Anaesthetists’ guidelines.

7.30 has confirmed nurses administered drugs in The Canberra Hospital’s gastroenterology suites, from 2000 to 2016, outside Australian anaesthesia guidelines.

The drugs included the potent anaesthetic drug propofol, as well as the strong sedatives fentanyl and midazolam.

Under the guidelines, the use of propofol for general anaesthetic or sedation should be reserved for anaesthetists or doctors with specialised training, who are solely responsible for the sedation.

Guidelines state that “deeper sedation or general anaesthesia must not be used unless an anaesthetist, or other trained and credentialed medical practitioner within his/her scope of practice, is present”.

Where such a practitioner is not present, propofol must not be used.

7.30 has been told nurses at The Canberra Hospital did not receive specific training or accreditation for sedation from the anaesthesia department.

The practice is known as Endoscopist-Directed-Nurse-Administered-Propofol-Sedation (EDNAPS).

‘This is very dangerous practice’

EDNAPS is common in some parts of Europe and the United States but is not accepted practice in Australia, due to different levels of relevant nurse-training and concerns about safety.

President of the Australian Society of Anaesthetists, associate professor David Scott, whose role is to represent anaesthetists, said it was misleading to refer to EDNAPS as “sedation” because the combination of fentanyl, midazolam and propofol could quickly progress to general anaesthesia.

“This is very dangerous practice and strictly forbidden in all the major guidelines,” he said.

“It’s playing with patients’ lives to save a few dollars.”

Hospital directed to stop after emergency team called in July 2015

In October 2015 ACT Health’s executive director of healthcare improvement, associate professor Deborah Browne, directed that EDNAPS should be stopped at the hospital after it was revealed that a patient undergoing an emergency gastroscopy in July 2015 stopped breathing and required support from the hospital’s Medical Emergency Team (MET).

The patient had a large “food bolus” in their oesophagus and had several pre-existing problems making them high risk for anaesthesia and not suitable for sedation.

The next day, the patient needed a second procedure to dislodge the food obstructing their oesophagus, this time under general anaesthetic and with intubation, attended by an anaesthetist.

The incident led anaesthetists at the hospital to raise concerns about the safety of EDNAPS.

Internal email shows widespread dissent

The July 2015 case was the subject of a scathing email sent to senior members of ACT Health and members of the hospital’s anaesthesia department, obtained by 7.30.

The email reveals many anaesthetists at the hospital believe the patient was unsuitable for EDNAPS and should have been excluded, as he was obese, bearded, with a potentially difficult airway and “potentially undiagnosed sleep apnoea”.

The email reveals the patient’s oxygen levels dropped dangerously low, which prompted the emergency call to the MET team, 45 minutes into the procedure.

Hospital director of anaesthesia queries the guidelines

The hospital’s director of anaesthesia, Professor Thomas Bruessel said he was aware that EDNAPS was occurring.

When asked about the opposition to EDNAPS raised by many anaesthetists at the hospital, he said he did not endorse the practice.

“As a representative of the college [of anaesthetists] and the director of anaesthesia we need to follow [the relevant guideline] PS09,” he said.

But Professor Bruessel also said more recent evidence meant the guidelines should consider other ways that propofol could be given safely.

“My personal ideas about what could and should happen is not what the college [of anaesthetists] thinks,” he said.

Hospital stopped EDNAPS in 2016

Following the directive from the Health Department in October last year, the hospital suspended the practice and arranged for anaesthetists to administer the drugs during endoscopies instead of nurses.

However, 7.30 has been told by sources within the hospital that EDNAPS continued on at least one occasion early this year and after the Health Department direction.

Associate Professor Browne, who issued the Oct 2015 direction, was approached for comment but was overseas and not available.

A spokesperson for ACT Health confirmed that EDNAPS was eventually stopped in January 2016, after “a period of transition”.

7.30 understands there is an ongoing project looking at the hospital’s sedation practices which includes an open submissions process that closed in October 2016.

Asked whether EDNAPS may commence again at the hospital following the open submission process, ACT Health’s spokesperson stated: “An EDNAPS research project is being considered by the Canberra Hospital, but a final proposal has not been developed or submitted.”

This post originally appeared on ABC News.