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.