Evidence-based Practice Project on Sedation in the Mechanically Ventilated Adult Patient in the Critical Care Unit

2.50
Hdl Handle:
http://hdl.handle.net/10755/157141
Category:
Abstract
Type:
Presentation
Title:
Evidence-based Practice Project on Sedation in the Mechanically Ventilated Adult Patient in the Critical Care Unit
Author(s):
Montague, Jill
Author Details:
Jill Montague, Alaska Native Medical Center, Anchorage, Alaska, USA, email: jmontagu@anthc.org
Abstract:
PURPOSE: To implement an interdisciplinary driven evidence based practice protocol to adequately manage, treat, and evaluate sedation, agitation, delirium, and pain in the ventilated patient in the critical care unit; to improve patient outcomes as evidenced by decreased ventilator days, increased patient and family and nurse satisfaction. Description: After identification of inconsistencies when medicating ventilated patients in the critical care unit (CCU) an evidence based practice project was initiated. A review and synthesis of the literature identified several areas for improvement in our CCU. We were utilizing the Ramsey scale, an out dated scale. In addition, our sedation protocol was outdated. Patients ended up on sedation drips at very high doses, prolonging ventilator time and length of stay in the CCU and the hospital. In addition, our CCU had experienced a high turnover of experienced staff necessitating the need to "grow our own" resulting in a high percentage of inexperienced and new nurses. The Riker sedation agitation scale (SAS) was selected. Staff education was done and the flow sheet was modified for the new scale. Previous studies suggest that there are improved patient outcomes when patients are given a sedation holiday. A pilot project raised questions about the safety of sedation holidays. The most current literature supports tapering of sedation with the goal of keeping patients at a sedation goal. EVALUATION: The Data collection instrument found documentation of the SAS at 64%. Patients receiving combination drug infusions 50% with 86% of patients at sedation goal. Analysis of the data showed poor documentation of pain in the non-verbal patient, pain was documented 23% of the time. The EBP team is currently looking at the evidence to implement a non-verbal pain scale. In addition, guidelines are needed for titration of drips up or down based on the patients SAS and # of PRN medication. Protocol changes are underway to decrease inconsistencies and provide guidelines when sedating ventilated patients improving nurse satisfaction and patient outcomes by decreasing complications and length of stay.
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 Project on Sedation in the Mechanically Ventilated Adult Patient in the Critical Care Uniten_GB
dc.contributor.authorMontague, Jillen_GB
dc.author.detailsJill Montague, Alaska Native Medical Center, Anchorage, Alaska, USA, email: jmontagu@anthc.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157141-
dc.description.abstractPURPOSE: To implement an interdisciplinary driven evidence based practice protocol to adequately manage, treat, and evaluate sedation, agitation, delirium, and pain in the ventilated patient in the critical care unit; to improve patient outcomes as evidenced by decreased ventilator days, increased patient and family and nurse satisfaction. Description: After identification of inconsistencies when medicating ventilated patients in the critical care unit (CCU) an evidence based practice project was initiated. A review and synthesis of the literature identified several areas for improvement in our CCU. We were utilizing the Ramsey scale, an out dated scale. In addition, our sedation protocol was outdated. Patients ended up on sedation drips at very high doses, prolonging ventilator time and length of stay in the CCU and the hospital. In addition, our CCU had experienced a high turnover of experienced staff necessitating the need to "grow our own" resulting in a high percentage of inexperienced and new nurses. The Riker sedation agitation scale (SAS) was selected. Staff education was done and the flow sheet was modified for the new scale. Previous studies suggest that there are improved patient outcomes when patients are given a sedation holiday. A pilot project raised questions about the safety of sedation holidays. The most current literature supports tapering of sedation with the goal of keeping patients at a sedation goal. EVALUATION: The Data collection instrument found documentation of the SAS at 64%. Patients receiving combination drug infusions 50% with 86% of patients at sedation goal. Analysis of the data showed poor documentation of pain in the non-verbal patient, pain was documented 23% of the time. The EBP team is currently looking at the evidence to implement a non-verbal pain scale. In addition, guidelines are needed for titration of drips up or down based on the patients SAS and # of PRN medication. Protocol changes are underway to decrease inconsistencies and provide guidelines when sedating ventilated patients improving nurse satisfaction and patient outcomes by decreasing complications and length of stay.en_GB
dc.date.available2011-10-26T19:27:31Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:27:31Z-
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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