Moderate Sedation Risk Tool & Workflow, OTV SmartPhrase Prostate Symptoms

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.title[
# Moderate Sedation Risk Tool & Workflow, OTV SmartPhrase Prostate Symptoms
]
.author[
### Walter Chin, Pretesh Patel
]
.date[
### June 6, 2025
]

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# 🛡️ Risk Mitigation Strategy

> Identify patients who may need **moderate sedation** during procedures early and consistently.

- 🧮 **Scoring Tool** evaluates risk across:
  - Airway, breathing, cardiac history, medications, frailty, communication
- 📊 **Total Score:**
  - **0–3** → Nurse-led care  
  - **4–7** → Signal sent to Attending for review  
  - **8+ or auto-flag** → Signal sent to Attending; *consider Pre-Anesthesia Evaluation*

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  <img src="i.jpg" width="530px">
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# 🔁 Sedation Workflow (EPIC Integrated)

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# 📝 Moderate Sedation Risk – Assessment Questions

**✔️ Scored Questions**
These contribute to the composite sedation risk score:

- Positioning tolerance  
- History of sedation problems  
- Prior anesthesia involvement  
- Airway concerns (short neck or limited mouth opening)  
- Lung conditions (e.g., OSA, CPAP, COPD)  
- Heart conditions (e.g., CHF, A-fib, cardiac history)  
- Age ≥ 70  
- Needs help with activities of daily living (ADLs)  
- Medication/substance history (opioids, benzos, substance use)

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# ⚠️ Not Scored (Informational Only)

These are collected for context but **do not impact the total risk score**:

- Height and weight  
- BMI and BSA  
- Arrangement for transportation  
- Orientation/cognition (e.g., alert and oriented)  
- Memory or cognitive impairment  
- Anxiety or fear about the procedure

💡 *These fields may still guide clinical decision-making, even if not included in scoring.*

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# Toxicity & Symptom Assessment (Prostate)

> During EPIC CLG discussions, clinical teams identified the need for a **more focused and efficient way to assess prostate patients** during weekly OTVs.

- Current documentation does not allow for free text for **symptom specificity**
- There's variation in how symptoms are assessed and recorded in the text section
- Teams want a solution that supports **streamlined nursing input** and improves **symptom-based interventions**

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# 💡 Proposed Solution: SmartPhrase Integration

- Implement a **targeted SmartPhrase** for *pointed pelvic patients (prostate)*
- Embed in the **free-text section of the OTV note**
- Focus on:
  - ✅ **Urinary Symptoms**
  - ✅ **GI Symptoms (e.g., radiation proctitis, diarrhea)**
- Goal: **Increase specificity**, support clinical decision-making, and improve patient care during RT

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# 📝 OTV SmartPhrase – Prostate Patients
1. Nurse completes rooming and OTV toxicity screening
2. Nurse uses OTV SmartPhrase
3. Nurse Assessment – Urinary Symptoms

Questions:
-Have your urinary symptoms worsened since RT started? (Yes/No)
-Do you feel you need medication for this? (Yes/No)
-Current urinary symptom meds: [Auto-populated med list]

- 🧪 Nursing Actions & Interventions
Medication Review

- Review current meds (purpose, dose, frequency, side effects)

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# 🚦 Symptom Management Protocol Tables

**🧪 Urinary Symptom Protocol – Medication Escalation**

| Protocol | Medication        | Class             | Notes                                                               |
|----------|-------------------|-------------------|----------------------------------------------------------------------|
| A        | Tamsulosin        | Alpha-Blocker     | Eases urine flow by relaxing bladder neck/prostate muscles          |
| B        | Phenazopyridine   | Urinary Analgesic | Short-term relief for burning, pain, urgency                        |
| C        | Oxybutynin        | Anticholinergic   | Reduces spasms and urgency if not responsive to A/B                 |

📌 *Start with Protocol A and escalate as clinically indicated.*

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#⚕️ GI Symptom Support – Radiation Proctitis / Diarrhea

| Medication                    | Class             | Purpose                                                    |
|-------------------------------|-------------------|------------------------------------------------------------|
| Loperamide (Imodium)          | Antidiarrheal     | Controls loose stools                                      |
| Docusate Sodium               | Stool Softener    | Prevents constipation, supports bowel regulation           |
| Sucralfate / Mesalamine enemas| Rectal Therapies  | Treats irritation/proctitis from pelvic radiation          |

🧾 *Nurses may recommend or escalate based on GI symptom pattern.*

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# 🧾 Nurses may recommend or escalate based on GI symptom pattern.

- 🧠 Clinical Support Summary
SmartPhrase enables structured OTV documentation

- Nurses assess and escalate using protocol-based logic

- Medication options grouped by symptom cluster

- Designed for prostate patients during weeks 3–6 of RT