The goal of a procedural sedation program is to provide the best standard of care, yielding the best outcome for the patient. The policy sets the framework for the practice. It is the presence of a strong quality and risk management structure that ensures the practices outlined in the policy are appropriately and consistently applied at the point of care. In the USA, several regulatory bodies have promulgated regulations or developed guidelines regarding the administration of procedural sedation, both at state and federal levels. The purpose of the quality and practice improvement program is to ensure best practice at the point of care through the review and evaluation of key care processes and patient outcomes, along with the oversight committee, to provide a systematic approach to safe, consistent practice. Risk management and quality are involved to varying degrees with most responses, working closely with local leadership and other expert practitioners.