In line with international practice, more medical practitioners and other healthcare providers are involved in the practice of sedation for procedures performed in facilities outside the traditional operating theatre. These may include various procedures in radiology, cardiology, plastic surgery, dermatology and dentistry, to name a few.
In South Africa, general practitioners were involved in sedation practice before sedation training or any guidance for safe sedation practice was available. There was also very little coherence in terms of standards, monitoring, guidelines and training in specific sedation techniques. It was clear that anaesthetists had to get involved in the training of all sedation providers.
Under the leadership of Prof James Roelofse formal training in sedation was initiated. Since the year 2000 a part-time post-graduate diploma course in sedation and pain control was offered, initially at the University of Stellenbosch, and later at the University of the Western Cape. During this time more than 300 sedation providers obtained this diploma, 15 an MSc, and one PhD. Sedation training was also started in the UK in collaboration with University College London since 2003.
Another milestone was the inception of the Society of Sedation Practitioners of South Africa (SOSPOSA). SOSPOSA is a member of the International Federation of Dental Anaesthesiology Societies (IFDAS). SOSPOSA supports structured sedation training and research. SASA sedation guidelines were drafted for both adult and paediatric patients. The 2010 Sedation Guidelines for adults was updated in 2015 and the revised Paediatric Guidelines will be launched at the Paediatric Anaesthesia Congress in November 2016.
Sedation practitioners involved in sedation outside the operating environment should take note of and follow the SASA Sedation Guidelines which spells out what safe sedation practice entails. A new item in the guidelines is the concept of clinical governance. SOSPOSA remains concerned about the safety of patients receiving sedation outside the operating theatre, in offices and surgeries. Apart from adherence to sedation guidelines it is also important that sedation be done by trained sedation practitioners. Facilities must meet the requirements for safe practice. Facilities where these procedures are performed should be appraised and accredited. Guidance on this can be found as a "practice appraisal form" at the back of the SASA Guidelines. This form should be checked and filled out, also by the sedation practitioner.
SOSPOSA has engaged with the Council for Health Service Accreditation of Southern Africa (COHSASA) to look at Standards for Procedural Sedation and Analgesia incorporating the SASA Guidelines. In this way we want to make a contribution to safe sedation practice. Standards and accreditation requirements for day-care clinics, sedation clinics and rooms/surgeries where sedation is performed are being prepared. This is in line with all international sedation guidelines on safe sedation practice.
Medical insurance companies are increasingly concerned about safe sedation and especially qualifications of sedation practitioners. They are also concerned whether facilities/surgeries meet the requirements for safe practice. We hope to address all these potential problems with the direction we are moving in.
In the end the aim of all these efforts is to ensure not only patient safety, but also to protect practitioners who deliver these services.
See also International Scheduling of Ketamine