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This period begins with the administration of sedation and extends to the end of the procedure when the scope is withdrawn (Table 3.3). An important consideration during this period is the appropriate documentation of care provided to the patient in the form of written intraprocedure record (sedation records) and photo documentation. During the procedure, important vital sign documentation should occur at intervals no greater than 5 minutes for pulse, oxygenation, and blood pressure. Photos should be taken to establish important landmarks were met for completion of exam. For example, a photo of cecal base or of the duodenum confirms the maximal depth of scope insertion was achieved. In addition to photos of important landmarks, care should be taken to photograph abnormalities found or therapies performed [1, 11, 14]. To improve the safety and efficacy of sedation, the use of reversal agents (flumazenil, naloxone) or discontinuation of propofol due to excessive sedation should be recorded. While data on reversal agents may be used for staff education and quality improvement, it should not be used to penalize physicians as this may cause reluctance to use these life‐saving medications.

Table 3.3 Intraprocedure quality indicators.

Patient monitoring	Vital signs (BP, pulse, oxygenation) recorded at least Q5 minutes
Medications	Dose, route, and timing of all medications used is recorded
Photodocumentation	Major landmarks and findings are photodocumented
Sedation reversal	Need to reverse sedation with naloxone, romazicon, or cessation of propofol due to oversedation is recorded

As previously stated, specific endoscopic procedures have specific quality indicators associated with their technical aspects.

Training in endoscopy should also include a thorough familiarity with these indicators.