Sleep tight...but can you squeeze my hand?: The Role of the CNS in the Management of Sedative Practices for Mechanically Ventilated Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/164150
Category:
Abstract
Type:
Presentation
Title:
Sleep tight...but can you squeeze my hand?: The Role of the CNS in the Management of Sedative Practices for Mechanically Ventilated Patients
Author(s):
Murray, Theresa
Author Details:
Theresa Murray, RN, MSN, CCRN, Community Health Network, Indianapolis, Indiana, USA, email: nacnsorg@nacns.org
Abstract:
Problem/Significance: Among patients who are mechanically ventilated, discomfort associated with the endotracheal tube and other devices requires routine administration of analgesics and anxiety relieving medications. Existing guidelines address the practice of sedative administration, however, there has not been wholesale adoption of this practice, and thus actual clinical practice is variable. In addition, the practice of "daily wakeup" - a procedure for withholding sedative medications until the patient can follow commands, becomes agitated, or is objectively uncomfortable - has been described as a necessary safeguard against over sedation. This practice is potentially harmful and clinical outcomes demonstrate that standardizing sedative medication use and eliminating "wakeup" is superior to outcomes published in the literature where the daily wakeup is used. Purpose: This project aimed to create a standardized protocol for medication management of discomfort among ventilated patients in an ICU setting. Description of Project: Physicians, nurses, and pharmacists designed and implemented a sedation scale and protocol that empowered nurses to meet therapeutic goals for anxiety management while eliminating the occurrence of over-sedation. Methods: The critical care clinical nurse specialist of this Midwestern integrated health network led a multidisciplinary team to implement evidenced based interventions to improve the practice of the administration of anxiety relieving medications. The team standardized drug selection and administration guidelines - using a scale and protocol. The team effectively worked to change the language (and thinking) to "anxiety relieving medications" from the old term "sedatives." Outcomes: This protocol has been successfully implemented in 3 ICUs within this integrated network. The outcomes associated with nurses using the standardized guidelines included decreases in length of stay, incidences of ventilator associated pneumonia, cost per day, and mortality. Conclusions/Nursing Implications: The outcomes in this health care network demonstrate that the practice of managing the anxiety among ventilated ICU patients can be accomplished by use of a specific, standardized protocol developed by a multidisciplinary team and implemented by staff nurses. The practice of the daily wakeup is not necessary if the staff is educated and empowered to manage the anxiety of the patients.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2005
Conference Name:
CNS Leadership: Navigating the Healthcare Environment Toward Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Orlando, Florida, USA
Description:
Conference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, 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_US
dc.typePresentationen_GB
dc.titleSleep tight...but can you squeeze my hand?: The Role of the CNS in the Management of Sedative Practices for Mechanically Ventilated Patientsen_GB
dc.contributor.authorMurray, Theresaen_US
dc.author.detailsTheresa Murray, RN, MSN, CCRN, Community Health Network, Indianapolis, Indiana, USA, email: nacnsorg@nacns.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/164150-
dc.description.abstractProblem/Significance: Among patients who are mechanically ventilated, discomfort associated with the endotracheal tube and other devices requires routine administration of analgesics and anxiety relieving medications. Existing guidelines address the practice of sedative administration, however, there has not been wholesale adoption of this practice, and thus actual clinical practice is variable. In addition, the practice of "daily wakeup" - a procedure for withholding sedative medications until the patient can follow commands, becomes agitated, or is objectively uncomfortable - has been described as a necessary safeguard against over sedation. This practice is potentially harmful and clinical outcomes demonstrate that standardizing sedative medication use and eliminating "wakeup" is superior to outcomes published in the literature where the daily wakeup is used. Purpose: This project aimed to create a standardized protocol for medication management of discomfort among ventilated patients in an ICU setting. Description of Project: Physicians, nurses, and pharmacists designed and implemented a sedation scale and protocol that empowered nurses to meet therapeutic goals for anxiety management while eliminating the occurrence of over-sedation. Methods: The critical care clinical nurse specialist of this Midwestern integrated health network led a multidisciplinary team to implement evidenced based interventions to improve the practice of the administration of anxiety relieving medications. The team standardized drug selection and administration guidelines - using a scale and protocol. The team effectively worked to change the language (and thinking) to "anxiety relieving medications" from the old term "sedatives." Outcomes: This protocol has been successfully implemented in 3 ICUs within this integrated network. The outcomes associated with nurses using the standardized guidelines included decreases in length of stay, incidences of ventilator associated pneumonia, cost per day, and mortality. Conclusions/Nursing Implications: The outcomes in this health care network demonstrate that the practice of managing the anxiety among ventilated ICU patients can be accomplished by use of a specific, standardized protocol developed by a multidisciplinary team and implemented by staff nurses. The practice of the daily wakeup is not necessary if the staff is educated and empowered to manage the anxiety of the patients.en_GB
dc.date.available2011-10-27T11:42:58Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:42:58Z-
dc.conference.date2005en_US
dc.conference.nameCNS Leadership: Navigating the Healthcare Environment Toward Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationOrlando, Florida, USAen_US
dc.descriptionConference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USAen_US
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.en_US
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