2.50
Hdl Handle:
http://hdl.handle.net/10755/182294
Category:
Abstract
Type:
Presentation
Title:
EBP Project on Sedation in the Mechanically Ventilated Adult Patient in the Critical Care Unit
Author(s):
Montague, Jill
Author Details:
Jill Montague, RN, BSN, CCRN, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA, email: jmontagu@anthc.org
Abstract:
After identification of inconsistencies when medicating ventilated patients in the critical care unit; an EBP project was initiated. A review and synthesis of the literature identified several areas for improvement. We were utilizing an outdated sedation protocol and the Ramsey scale. Patients ended up on sedation drips at very high doses, prolonging ventilator time and length of stay. 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. 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 questions the practice of sedation holidays. As a best practice we incorporated tapering of sedation with the goal of keeping patients at a sedation goal. We developed a data collection instrument which found documentation of the SAS at 64%. Patients receiving combination drug infusions 50% with 86% of patients at sedation goal. Pain was documented 23% of the time in the non-verbal patient. The team is currently looking at the evidence to implement a non-verbal pain scale. In addition, guidelines are needed for titration of drips based on the patients SAS and # of PRN medication. Protocol changes are underway to provide guidelines for sedation to improve nurse satisfaction and patient outcomes. References: Egerod, I. (2002). Uncertain terms of sedation in ICU. How nurses and physicians manage and describe sedation for mechanically ; Bruno, J. J., & Canada, T. W. (2006). Daily sedative interruption in mechanically ventilated patients: limited data, numerous concerns. Hospital Pharmacy, 41 (10), 943-951.; Chanques, G., Jaber, S., Barbotte, E., Violet, S., Sebbane, M., Perrigault, P., et al. (2006). Impact of systematic evaluation of pain and agitation in an intensive care unit. Critical Care Medicine, 34 (6), 1691-1699.; Elliott, R., McKinley, S., & Aitken, L. (2006). Adoption of a sedation scoring system and sedation guideline in an intensive care unit. Journal of Advanced Nursing, 208-216.; Jacobi, J., Fraser, G. L., Coursin. D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., et al. (2002). Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical care medicine, 30 (1), 119-141; Pandharipande, P., Shintani, A., Peterson, J., Pun, B. T., Wilkinson, G. R., Dittus, R. S., et al. (2006). Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology, 104 (1), 21-26; Shaw, G. M., Chase, J. G., Rudge, A. D., Starfinger, C., Lam, Z., Lee, D., et al. (2003). Rethinking sedation and agitation management in critical illness. Critical care and Resuscitation, 5, 198-206; Williams, T. A., Martin, S., Leslie, G., Thomas, L., Leen, T., Tamaliunas, S. (2008). Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain scales. American Journal of Critical Care, 17 (4), 349-356.
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2009
Conference Name:
ANCC National Magnet Conference
Conference Host:
American Nurses Credentialing Center
Conference Location:
Louisville, Kentucky, USA
Description:
"Magnet: Inspiring Innovation, Achieving Outcomes" was the theme and "Explore the relationship among leadership, innovation, and nursing practice outcomes" was the goal of the 13th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 1-3 October, 2009 in Louisville, Kentucky, 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.titleEBP Project on Sedation in the Mechanically Ventilated Adult Patient in the Critical Care Uniten_GB
dc.contributor.authorMontague, Jillen_US
dc.author.detailsJill Montague, RN, BSN, CCRN, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA, email: jmontagu@anthc.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/182294-
dc.description.abstractAfter identification of inconsistencies when medicating ventilated patients in the critical care unit; an EBP project was initiated. A review and synthesis of the literature identified several areas for improvement. We were utilizing an outdated sedation protocol and the Ramsey scale. Patients ended up on sedation drips at very high doses, prolonging ventilator time and length of stay. 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. 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 questions the practice of sedation holidays. As a best practice we incorporated tapering of sedation with the goal of keeping patients at a sedation goal. We developed a data collection instrument which found documentation of the SAS at 64%. Patients receiving combination drug infusions 50% with 86% of patients at sedation goal. Pain was documented 23% of the time in the non-verbal patient. The team is currently looking at the evidence to implement a non-verbal pain scale. In addition, guidelines are needed for titration of drips based on the patients SAS and # of PRN medication. Protocol changes are underway to provide guidelines for sedation to improve nurse satisfaction and patient outcomes. References: Egerod, I. (2002). Uncertain terms of sedation in ICU. How nurses and physicians manage and describe sedation for mechanically ; Bruno, J. J., & Canada, T. W. (2006). Daily sedative interruption in mechanically ventilated patients: limited data, numerous concerns. Hospital Pharmacy, 41 (10), 943-951.; Chanques, G., Jaber, S., Barbotte, E., Violet, S., Sebbane, M., Perrigault, P., et al. (2006). Impact of systematic evaluation of pain and agitation in an intensive care unit. Critical Care Medicine, 34 (6), 1691-1699.; Elliott, R., McKinley, S., & Aitken, L. (2006). Adoption of a sedation scoring system and sedation guideline in an intensive care unit. Journal of Advanced Nursing, 208-216.; Jacobi, J., Fraser, G. L., Coursin. D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., et al. (2002). Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical care medicine, 30 (1), 119-141; Pandharipande, P., Shintani, A., Peterson, J., Pun, B. T., Wilkinson, G. R., Dittus, R. S., et al. (2006). Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology, 104 (1), 21-26; Shaw, G. M., Chase, J. G., Rudge, A. D., Starfinger, C., Lam, Z., Lee, D., et al. (2003). Rethinking sedation and agitation management in critical illness. Critical care and Resuscitation, 5, 198-206; Williams, T. A., Martin, S., Leslie, G., Thomas, L., Leen, T., Tamaliunas, S. (2008). Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain scales. American Journal of Critical Care, 17 (4), 349-356.en_GB
dc.date.available2011-10-28T15:17:53Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T15:17:53Z-
dc.conference.date2009en_US
dc.conference.nameANCC National Magnet Conferenceen_US
dc.conference.hostAmerican Nurses Credentialing Centeren_US
dc.conference.locationLouisville, Kentucky, USAen_US
dc.description"Magnet: Inspiring Innovation, Achieving Outcomes" was the theme and "Explore the relationship among leadership, innovation, and nursing practice outcomes" was the goal of the 13th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 1-3 October, 2009 in Louisville, Kentucky, USA.en_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.-
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