reaching the patient This may be related to the lack of a pharmacist’s involvement in most ED decisions The Joint Commission advocates a “time-out” before any medication is given to verify the correct patient, site, and medications Anticipate complications such as laryngospasm or vomiting Have a backup plan for complications before they arise The Joint Commission emphasizes the concept of “sedation rescue,” which is essential to safe sedation The ability to rescue a patient after an adverse event is also emphasized by AAP guidelines Documentation Careful documentation of the use of sedatives and analgesics is important If an inpatient or outpatient record already exists, there is no need to repeat the information previously documented However, a brief note is recommended to indicate that the chart was reviewed before giving sedative agents A note indicating the child’s presedation status is helpful and there should be a notation that the patient’s condition has not changed since arrival or since the last examination in the record When using sedatives and analgesics, a well-designed, time-based record is essential The use of a separate form or checklist is particularly useful as a supplement to the ED note The checklist may improve efficiency and may serve to remind the caregiver to ask specific questions or perform a specific part of the physical examination The record should indicate any history of allergies or adverse drug reactions, as well as medications used prior to sedation It is wise to place this information near the section for writing the sedation orders so they can be reviewed when medications are ordered The physical examination should focus on the airway and cardiovascular system It is also helpful to document the child’s level of consciousness during the procedure (e.g., how he or she responds to verbal commands or tactile stimulation) Note the patient’s level of consciousness again prior to discharge Discharge instructions must be reviewed with the child’s guardian before the patient is allowed to go home They should include a reminder to parents that the child should not be involved in activities that require coordination, such as bicycle riding or skating, for perhaps 24 hours Adult supervision should be recommended for at least hours Unsupervised bathing and use