| Learning Objective #1: Define the value of implementing research finding from consensus articles | |||
| Learning Objective #2: Describe the value of a nurse-driven sedation protocol on ventilated patient outcomes |
Anxiety and agitation are common problems among critically ill adults in the intensive care unit. The American College of Critical Care Medicine (ACCM) of the Society of Critical Medicine (SCCM) published guidelines for the care of critically ill adult in the article; Sedation, Analgesia and Neuromuscular Blockage (American Journal of Health Systems and Pharmacy, January 15, 2002, pp. 147-177). The guideline outline best practice for the ventilated intensive care patients. Concomitant with these guidelines are suggestions of daily interruption of sedative infusions to ascertain the patient’s mental status. Outcomes measurements of reduced length of ICU and hospital stay, length of ventilator time, amount and type of medication used and frequency of neurological examinations/tests were compared in a random controlled study (Kress, et al, May 2000). A task force representing pharmacy services, intensive care nursing, and medicine was convened across a hospital care system of a large Midwestern health service in a effort to implement the best practice guidelines outlined in the literature. Two order forms were created to define the short and long term suggested medication selection and dosing. Implementation of a sedation assessment scoring method and numeric documentation was incorporated into the order form to assure pre- and post-assessment of the patient’s response to the medication. Data collection of key outcome measurements include: Analgesia and sedative medication selection, dosing and method of administration, Riker SAS scoring pre- and post- medication administration or titration; ventilator time and length of stay. Other criteria explored are self-extubation data, ventilatory infectious disease complications and patient tolerance to wean. Wake-up procedures when implemented on a ordered basis by the physician was measured to determine the value of this method and the possibility of reducing or discontinuing the sedative medication based on underlying patient response. Outcome data of this research utilization project will be discussed.
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