Governance

Governance issues include the following:

Training

The guideline is clear:

“Ketamine should be only used by clinicians experienced in its use and capable of managing any complications, particularly airway obstruction, apnoea and laryngospasm. The doctor managing the ketamine sedation and airway should be suitably trained and experienced in ketamine use, with a full range of advanced airway skills.”

Discuss with senior colleagues how you might secure competency; consider specific manikin-based workshops on laryngospasm.

Documentation and audit

A dedicated electronic, password-protected database with mandatory entry for ketamine sedation is probably the key, coupled with timely analysis by a named departmental sedation lead.

Risk management

In the audit process consider:

• Was a specific sedation monitoring chart used?
• Were the indications for ketamine sedation appropriate?
• Were any contra-indications acknowledged?
• What complications arose and how were they managed?

Pre-emptive strategies might also include:

• Ready access to the College guideline
• A dedicated monitoring chart for ketamine sedation
• A system of support for addressing laryngospasm
• Selection and storage of ketamine vials (as discussed previously)

Learning bite

There should be a documentation and audit system in place within a framework of clinical governance.