2.50
Hdl Handle:
http://hdl.handle.net/10755/157084
Category:
Abstract
Type:
Presentation
Title:
Evidence-based Practice: Hyperosmolar Therapy in Neurocritical Care
Author(s):
Hujcs, Marianne; Kennedy, Rosemary
Author Details:
Marianne Hujcs, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA, email: hujcsm@uphs.upenn.edu; Rosemary Kennedy
Abstract:
PURPOSE: Practice variations exist in the treatment of intracranial pressure (ICP) in neurocritical care. While parameters for administering hyperosmolar agents to reduce ICP have been established for mannitol, no accepted guidelines are available for hypertonic saline (HTS). A performance improvement project was undertaken to standardize co-administration of mannitol and HTS in patients with ICP greater than 20mmHg after traumatic brain injury, subarachnoid hemorrhage and stroke. Description: A systematic review of literature accomplished by an interprofessional neurocritical care team revealed compelling evidence to support the use of hyperosmotic agents in ICP management. Practice standards were developed for intravenous mannitol and HTS to promote clinical decision-making, and safe and efficient care. An educational program based on current research, medication safety, monitoring guidelines, collaborative care, and endpoints for desired treatment outcomes, prepared clinical nurses for independent and interdependent practice decisions. Prescribing guidelines for osmotherapy predicated on weight-based dosing, osmolar gap calculations, and criteria defining treatment response were outlined for physicians and nurse practitioners. If mannitol failed to reduce ICP, HTS was considered using 5% HTS solution by bolus delivery along with vigilant patient monitoring to assess response. A progressive titration protocol with 3% HTS solution via continuous infusion guided by a rate-based sliding scale was implemented if no improvement in ICP measurements and serum sodium were evident. A retrospective audit of medical records was conducted to measure practice compliance, patient outcomes and safety and effectiveness of care. EVALUATION: Results indicated that mannitol was first initiated for increased ICP when suggested (100% sample). Guidelines for 5% HTS administration were followed in 85% reviewed cases; reasons for protocol departure were identified and reviewed. Results also demonstrated that 5% HTS bolus reduced mean ICP below 20mmHg within 43 minutes. Finally, when ICP necessitated treatment with 3% HTS continuous infusion, results indicated that mean ICP decreased below threshold within an average 22 hours and that using a titration table safely guided this therapy. Our project demonstrated that implementing best evidence for practice, patient safety and team collaboration leads to improved patient outcomes.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, 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.titleEvidence-based Practice: Hyperosmolar Therapy in Neurocritical Careen_GB
dc.contributor.authorHujcs, Marianneen_GB
dc.contributor.authorKennedy, Rosemaryen_GB
dc.author.detailsMarianne Hujcs, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA, email: hujcsm@uphs.upenn.edu; Rosemary Kennedyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157084-
dc.description.abstractPURPOSE: Practice variations exist in the treatment of intracranial pressure (ICP) in neurocritical care. While parameters for administering hyperosmolar agents to reduce ICP have been established for mannitol, no accepted guidelines are available for hypertonic saline (HTS). A performance improvement project was undertaken to standardize co-administration of mannitol and HTS in patients with ICP greater than 20mmHg after traumatic brain injury, subarachnoid hemorrhage and stroke. Description: A systematic review of literature accomplished by an interprofessional neurocritical care team revealed compelling evidence to support the use of hyperosmotic agents in ICP management. Practice standards were developed for intravenous mannitol and HTS to promote clinical decision-making, and safe and efficient care. An educational program based on current research, medication safety, monitoring guidelines, collaborative care, and endpoints for desired treatment outcomes, prepared clinical nurses for independent and interdependent practice decisions. Prescribing guidelines for osmotherapy predicated on weight-based dosing, osmolar gap calculations, and criteria defining treatment response were outlined for physicians and nurse practitioners. If mannitol failed to reduce ICP, HTS was considered using 5% HTS solution by bolus delivery along with vigilant patient monitoring to assess response. A progressive titration protocol with 3% HTS solution via continuous infusion guided by a rate-based sliding scale was implemented if no improvement in ICP measurements and serum sodium were evident. A retrospective audit of medical records was conducted to measure practice compliance, patient outcomes and safety and effectiveness of care. EVALUATION: Results indicated that mannitol was first initiated for increased ICP when suggested (100% sample). Guidelines for 5% HTS administration were followed in 85% reviewed cases; reasons for protocol departure were identified and reviewed. Results also demonstrated that 5% HTS bolus reduced mean ICP below 20mmHg within 43 minutes. Finally, when ICP necessitated treatment with 3% HTS continuous infusion, results indicated that mean ICP decreased below threshold within an average 22 hours and that using a titration table safely guided this therapy. Our project demonstrated that implementing best evidence for practice, patient safety and team collaboration leads to improved patient outcomes.en_GB
dc.date.available2011-10-26T19:24:26Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:24:26Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_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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