Knowledge, Attitude and Practice of Out of Theatre Sedation by Anaesthesia Providers at The Kenyatta National Hospital

Abstract

Background: Sedation is a process whereby drugs are used to depress a person’s level of consciousness and inhibit their response to a noxious stimulus. It enables both therapeutic and diagnostic procedures to be done while ensuring the patient is comfortable. Sedation is increasingly being carried out in units within the hospital but outside the standard operating theatres. The same standards and quality of care is applied as that in theatre. Patient safety and that of the anaesthesia providers should be guaranteed. Objective: To assess the Knowledge, Attitude, and Practice (KAP) of sedation out of theatre by anaesthesia providers. Study Design: Cross sectional descriptive study. Study Setting: This study was carried out in Kenyatta National Hospital. Methodology: This study involved 94 Anaesthesia Providers practicing in Kenyatta National Hospital. It included Consultant Anaesthesiologists, Registered Clinical Officers in Anesthesia and Anaesthesia Residents. They answered an online questionnaire. To increase response rates, reminder emails and messages were sent to participants twice weekly during the period of data collection. The data collection covered a period of 1 month. Data Management: An online questionnaire was sent to the participants. Data collected was analyzed using SPSS version 24. and presented as frequencies and proportions. Utility of Study: The study will establish a baseline for anaesthesia Providers’ practices and knowledge to be able to extrapolate safe practices and protocols for the patient population in Kenyatta National Hospital. Results: There was a 100% response rate. The mean age of respondents was 37.0 years. Female respondents were more at 54.3% than male at 45.7%. 51.1% of the Anaesthesia Providers were Anaesthesia Residents, 25.5% Consultant Anaesthesiologists and 23.4% Registered Clinical Officers. There was an equal number of respondents affiliated to both KNH and UoN at 50% each. In relation to knowledge, 76.6% correctly noted that KNH does not have guidelines on sedation out of theatre. All equipment listed were required for sedation out of theatre however most favored were oxygen 98.9%, pulse oximeter 98.9% and suction 95.7%. The most preferred drugs required for sedation out of theatre were ketamine 98.9%, midazolam 97.9%and propofol 92.6 %. The gold standard for monitoring ventilation was correctly identified as capnography 72.3 %. 88.3% of the respondents agreed that the same fasting guidelines apply for sedation out of theatre as those for patients undergoing anaesthesia in theatre. xv 96% of the anaesthesia providers strongly agreed and 4% agreed that the introduction of protocols would improve the practice of sedation out of theatre. The respondents also thought that trainings, seminars and CMEs were very important 92% and important 8% in the practice of sedation out of theatre. 43% of the respondents disagreed that the units were well equipped to handle emergencies during sedation out of theatre, 19% strongly disagreed and 21% were neutral. 36% of the respondents were satisfied with the availability of drugs, 50% were dissatisfied with the availability of equipment, 49% were dissatisfied with team preparedness during emergencies and 33% were dissatisfied with availability of help/ assistance during emergencies. Majority of the anaesthesia providers had provided sedation services in the MRI/CT scan, endoscopy, clinic 66 and eye theatre. The units least frequented by the respondents were the wards, Cardiac Catheterization Lab and Casualty. On drug choice for sedation outside theatre 95% chose according to what was available and 90% according to the type of procedure being done. The least chosen determining factors were route of administration 66% and side effects 68%. Drug availability was used to assess availability of emergency drugs and antidotes used when adverse events occur when carrying out sedation out of theatre. Atropine and adrenaline were readily available at 99% and 96% respectively. Naloxone was not readily available at18%. Challenges experienced by the anaesthesia providers when carrying out sedation out of theatre. 83% of the respondents identified unfamiliar rooms and environment hence not knowing where drugs and equipment are kept as a challenge. Lack of sedation protocols 72% , inexperienced/ inadequate staff 70% and lack of a trained assistant 69%. Conclusion: The knowledge of the anaesthesia providers on various items on sedation out of theatre was good. Majority of the anaesthesia providers felt that the units where sedation is carried out are not well equipped to handle emergencies. The anaesthesia providers were dissatisfied with the availability of equipment, team preparedness during emergencies and availability of help/ assistance during emergencies. Drugs for use during sedation were chosen according to what was available and the procedure being done. Emergency drugs were readily available but the antagonist drugs were not readily available. The major challenges experienced when carrying out sedation out of theatre were unfamiliar rooms, lack of sedation protocols and inadequate/ inexperienced staff