Rest From Distress: Sedation and Analgesic Protocols For the Post-Op Cardiovascular Intensive Care Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/157058
Category:
Abstract
Type:
Presentation
Title:
Rest From Distress: Sedation and Analgesic Protocols For the Post-Op Cardiovascular Intensive Care Patients
Author(s):
Toews, Tracy A.; Bocci, Michael
Author Details:
Tracy A. Toews, RN,BSN,CCRN, The Methodist Hospital, Houston, Texas, USA, email: ttoews@tmhs.org; Michael Bocci
Abstract:
PURPOSE: Intubated patients are prone to distress during the postoperative period. These patients' care plans begin with treating the underlying causes of their distress, which are mainly due to pain, agitation, and delirium. The focus of management to alleviate these causes is a combination of medications and vigilant quality care. A team composed of multidisciplinary health care personnel in the CVICU developed sedation and analgesic protocols to decrease patients' postoperative distress. DESCRIPTION: When a patient is under distress, it can lead to patient self-harm and interruption of treatment, which may cause undue postoperative complications and may compromise patient safety. CVICU team members collaborated to evaluate and institute a unit-based sedation and analgesia protocol. Intubated postoperative patients admitted to the CVICU are sedated with continuous intravenous sedation medicine. If the patient is not going to be on fast track to extubation or fails the weaning parameters, then the patient is given a continuous sedation drip along with a continuous analgesic drip infused via controlled pumps. Antipsychotic medication is ordered as needed or with a maintenance dose for patients suffering from delirium. The goal of sedation is measured by the Richmond Agitation-Sedation Scale (RASS). Pain levels are assessed accordingly. The nurse titrates the medications per protocol to reach the ordered RASS score and patient comfort level. The patient is then frequently evaluated for the protocol's effectiveness. Daily sedation holidays to assess neurological status are implemented for each patient on continuous sedation and analgesia. The CVICU team works together to wean the medications and move the patient safely toward extubation. EVALUATION/OUTCOMES:Implementation of the protocol greatly improved the management of patientsÆ postoperative distress and promoted collaboration in the multidisciplinary team. Audits showed a downward trend in the mean length of stay in hours in the CVICU. The mean was 58.8 hours at the end of the second quarter and decreased to 47.3 hours by the end of the third quarter of this year. Because there was a low compliance with sedation holiday, the team set a daily time and revised the criteria that excluded patients from the holiday. Compliance improved from 89.6% in the second quarter to 93.7% in the third quarter of this year. As a result of this project, the sedation and analgesic protocols were implemented house wide.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleRest From Distress: Sedation and Analgesic Protocols For the Post-Op Cardiovascular Intensive Care Patientsen_GB
dc.contributor.authorToews, Tracy A.en_GB
dc.contributor.authorBocci, Michaelen_GB
dc.author.detailsTracy A. Toews, RN,BSN,CCRN, The Methodist Hospital, Houston, Texas, USA, email: ttoews@tmhs.org; Michael Boccien_GB
dc.identifier.urihttp://hdl.handle.net/10755/157058-
dc.description.abstractPURPOSE: Intubated patients are prone to distress during the postoperative period. These patients' care plans begin with treating the underlying causes of their distress, which are mainly due to pain, agitation, and delirium. The focus of management to alleviate these causes is a combination of medications and vigilant quality care. A team composed of multidisciplinary health care personnel in the CVICU developed sedation and analgesic protocols to decrease patients' postoperative distress. DESCRIPTION: When a patient is under distress, it can lead to patient self-harm and interruption of treatment, which may cause undue postoperative complications and may compromise patient safety. CVICU team members collaborated to evaluate and institute a unit-based sedation and analgesia protocol. Intubated postoperative patients admitted to the CVICU are sedated with continuous intravenous sedation medicine. If the patient is not going to be on fast track to extubation or fails the weaning parameters, then the patient is given a continuous sedation drip along with a continuous analgesic drip infused via controlled pumps. Antipsychotic medication is ordered as needed or with a maintenance dose for patients suffering from delirium. The goal of sedation is measured by the Richmond Agitation-Sedation Scale (RASS). Pain levels are assessed accordingly. The nurse titrates the medications per protocol to reach the ordered RASS score and patient comfort level. The patient is then frequently evaluated for the protocol's effectiveness. Daily sedation holidays to assess neurological status are implemented for each patient on continuous sedation and analgesia. The CVICU team works together to wean the medications and move the patient safely toward extubation. EVALUATION/OUTCOMES:Implementation of the protocol greatly improved the management of patientsÆ postoperative distress and promoted collaboration in the multidisciplinary team. Audits showed a downward trend in the mean length of stay in hours in the CVICU. The mean was 58.8 hours at the end of the second quarter and decreased to 47.3 hours by the end of the third quarter of this year. Because there was a low compliance with sedation holiday, the team set a daily time and revised the criteria that excluded patients from the holiday. Compliance improved from 89.6% in the second quarter to 93.7% in the third quarter of this year. As a result of this project, the sedation and analgesic protocols were implemented house wide.en_GB
dc.date.available2011-10-26T19:23:03Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:23:03Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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