" I have looked at the RA proposal and it is not viable on a number of levels".
1) "Dr. X would need to be sedation trained on an approved SAAD
course, and according to our conscious sedation policy he would need to
evidence that he was regularly practicing and delivering this as outlined in
the IACSD"
Incorrect
on both points.
A) SAAD do not approve courses. As of April 2015, it was the IACSD, on
which SAAD were just one of many stakeholders, who produced the latest
gold-standard guidelines and who can accredit courses. It was
Accreditation Sub-Committee, appointed by IACSD, who accredited my courses,
giving them the equivalence of a university-based module in this subject.
The Accreditation Sub-Committee was made up of senior SAAD and DSTG committee
members. In addition SAAD themselves cannot certify competence as they are not
set up to provide the required work-based assessments. SAAD & DSTG support
the IACSD guidelines.
Please see the recent website statements:
SAAD statement
B) This is a misreading of the
IACSD report. The only people for whom "regularly practising and
delivering" apply, are those covered by "Transitional
Arrangements".
These allow those already involved in delivering sedation prior to April
22nd 2015, to carry on. That does not apply to those newly
training to deliver sedation techniques and I am specifically
accredited to teach those new to sedation to the point of certifying their
competence to practice Inhalation sedation without further supervision.
2) The practice would need to be
compliant and pass a SAAD inspection (cost approx. £3k)
That is not so unless your organisation wishes it or has
been required to undertake the SAAD safe Sedation Scheme. e.g. by NHS
commissioners. I have had this confirmed by SAAD Committee member.
The correct equipment set-up and other formative assessments that I
make, during the 2 days of my Work-Based Assessments (WBAs) with each candidate
at their practices, will include the suitability of the practice and equipment
for carrying out safe Inhalation Sedation. In the event that there are
deficiency noted, these would be brought to your attention to be corrected by
day 2.
I reserve the right NOT to certify any candidate's competence, if in my
opinion they are not ready to deliver the service safely and proficiently after
my 3-day course. Thus far this has never happened.
Remember, Dr. X we will have discussed the details of the equipment
required, including, for example, a recognised method for active scavenging and
the correct venting of waste gases outside the building, a correctly
constructed "hole" in the exterior building wall either from a free
standing unit ( e.g. Mini-scav or similar) or if confirmed by the equipment
manufacturer as being safe to do so, via your central suction system, vented to
the outside.
3) If Dr. X was carrying out the sedation and the treatment he would need 2
nurses present, one with sedation training.
This is totally incorrect for inhalation Sedation. It shows a lack of
understanding I am afraid.
This ONLY APPLIES TO INTRA-VENOUS
SEDATION.
4) "The whole practice team involved in the delivery would need ILS
training and current gold standard is that this is specifically paediatric, and
we do not currently have this training as a business."
"Involved in the delivery" means you and your RDN.
ILS + PILS is correct, to comply with the guidelines.
ILS = BLS + AED + Deployable airway
(Do you cover these 3 elements in your practice's standard Life Support
training already?)
PILS must be "age-appropriate", which would be from, say for 4
years of age (no age is actually specified) and so will not need to
include elements required by the Resus Council's PILS courses covering
neo-nates and infants.
I have tried to arrange a 1-day ILS+PILS via independant resus trainers
without success so far. I may try again soon.
This means that for now at least you and your
nurse may have no option but to undertake a PILS course via the Resus Council
even though much of this will be irrelevant.
I have attached the IACSD FAQs which may
help several of the points raised too.
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5) Currently the CDO’s have referred the IACSD guidance to SCDEP for review
of guidance report regarding implementation in primary care.
That is true BUT SAAD & DSTG stand by the IACSD
report. If despite their advice, you choose to be guided by the CDO, then
currently you can choose to revert to the "Extant" guidelines of
2003.
I have no idea when the SCDEP will report and when they do so what they
will suggest. They may even reduce some requirements for "RA" but I
have no evidence for that!
2003 guidelines would mean you would be OK to ignore the PILS
requirements of IACSD and if you "felt competent", just go ahead to
practice without the need for the WBAs!
6) Evidence base demonstrates that IV sedation is more effective for
adult patients.
What evidence?
IVS has a higher morbidity and chance of complications. Over-sedation
with IVS is potentially more serious, not least if it occurs in the middle of a
surgical procedure. It has a much longer recovery period for patients and
requires a competent adult escort. However when it is indicated OR Inhal. Sed.
is contraindicated then yes, IVS would be the correct approach.
My evidence of 7-8000 patients over 38 years in a general practice
setting says it is entirely a matter of patient selection. I also have a
library of testimonials from adults whose lives we have changed let alone
treatment accomplished using inhalation Sedation.
In my private practice between 1999 (when I introduced IVS to add
to my Inhalation Sedation service) and 2014, I found that I used IVS once per month
and Inhalation Sedation 20 times per month on average.
In addition the latest guidelines requires us to use the least invasive
procedure.
From Page 6:
"Optimal care is patient-centred and
focuses on the needs of the individual". So not one-size fits
all."
From page 15: para2
“No one technique is suitable for all
patients. However, adopting the principle of minimum intervention, the simplest
and safest technique based on robust patient assessment and clinical need,
should be used. “
7) The practice would need to demonstrate to an outside body that the
delivery of sedation is safe, compliant and in patient’s best interests.
Having been accredited, then I can act as that outside body.
As mentioned above, if in my opinion the practitioner/practice is not
competent to provide Inhalation Sedation after the accredited 3-day
course has been completed then I will not certify their competence. A formative assessment report will be provided at the end of day 2 of the WBAs
In
case of any doubts, please write to Neil Sutcliffe of the IACSD. He
will answer your queries or refer them onto the appropriate IACSD
committee member
Neil Sutcliffe
NACPDE Administrator & Committee Manager
Royal College of Surgeons
Faculty of Dental Surgery
35-43 Lincoln's Inn Fields
London WC2A 3PET: 020 7869 6804E: nsutcliffe@rcseng.ac.ukW: www.rcseng.ac.uk
