Procedural Sedation Materials

Privileging requirements for Procedural Sedation approved by the Medical Staff

Initial Privileging Requirements

Requesting provider to review the following documents:

Current sedation protocol

2944 Procedural Sedation Protocol (AWH)

Airway assessment documents

Airway assessment for patients undergoing moderate sedation

Sedation Airway Algorithm

Capnography monitoring information

13363 End tidal carbon dioxide monitoring (capnography) (AWH)

Capnography education for physicians

Capnography test questions

Take and return the written sedation test (80% is passing) and agree to use Mallampati Scoring for Airway assessment.

Complete airway practical & capnography education through Central Wisconsin Anesthesia. Provider Support Services can assist in coordination of this requirement 715-847-2276 or pss@aspirus.org

Reappointment Privileging Requirements

Review/read current sedation protocol

Review airway assessment information and agree to document accordingly

Review capnography monitoring information

Send back a signed attestation form that verifies that you have reviewed the information and requirements, have performed five (5) procedures annually that involve sedation, and agree that you will perform procedures involving sedation according to current protocol.