Wasilowsky, Bonnie, BSPA-HCA, RN, CNRN

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingSedation Safety Using Clinical Practice GuidelinesBonnie Wasilowsky BSPA-HCA, RN, CNRNLehigh Valley Health Network, Bonnie.Wasilowsky@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Anesthesia and Analgesia Commons, Neurosciences Commons, and the NursingCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtWasilowsky, B. (2012, April 28- May 1). Sedation safety using clinical practice guidelines. Poster presented at: The 44th AnnualEducational Meeting of the American Association of Neuroscience Nurses, Seattle, WA.Lehigh Valley Health Network, Allentown, PennsylvaniaSedation Safety Using Clinical Practice GuidelinesBonnie Wasilowsky, BSPA-HCA, RN, CNRN, Patient Care Coordinator, Neuroscience Intensive Care UnitObjectives: Abstract:Neurological patients undergo repeated diagnostic tests, may be mechanically ventilated, and may require sedation. At one Magnet® hospital, the use of sedation is initiated and monitored using clinical practice guidelines, which serve to minimize patient risk. This presentation discusses two Clinical Practice Guidelines developed to safeguard patients. The Propofol Infusion Guideline outlines lab tests that should be drawn before and during infusion; mandates documentation of a sedation-agitation score; and requires the time to a neurological exam after Propofol is placed on hold. These factors assist the care team to judge effectiveness of the drug and dose. The Sedation During Testing Guideline requires sedation to be initiated 2 hours prior to non-emergent testing for safe and comparable level of pre-procedure and intra-procedure care. During testing, patients are monitored every five minutes to quickly recognize instability. The guidelines assure sedation can be a valuable tool when safety is the objective. 1.  Discuss the use of sedation as a means to minimize pain, discomfort, and intolerance of procedures while avoiding excessive or unnecessarily prolonged use. 2.  Review evidence addressing the impact of sedation practice and the potential patient safety concerns.3.  Detail two clinical practice guidelines that focus on safe sedation use in high risk patient situations.  LVHN Clinical Practice Guidelines:•  Propofol Infusion for Neurology Patients  -  Utilize Riker Sedation-Agitation Scale   - Identify target sedation-agitation score  -  Infuse and titrate to sedation-agitation score  -  Document sedation-agitation score every hour  -  Document length of time required before full neuro exam can be completed  - Outline steps required if time to exam is greater than ten minutes  -  Take precautions to decrease potential complications such as laboratory tests, nutrition consult, and tubing change •  Continuous Intravenous Sedation During Testing  -  Complete pre-procedure evaluation two hours before scheduled procedure  -  Evaluate airway stability and necessity of pre-procedure artificial airway placement  - Determine sedation/         analgesics for the procedure  -  Initiate medications two hours pre-procedure to evaluate patient response  -  Document parameters every five minutes during the procedure  -  Empower RN to stop procedure for instability  -  Document agitation score every hourSociety of Critical Care Medicine Guidelines for Sustained Use of Sedatives and Analgesics: •  Focus on pain, sedation, and delirium•  Start sedation for agitation  after pain is addressed•  Do not treat delirium with benzodiazepines - delirium can become worse•  Define upper limit doses of sedation•  Utilize goal directed therapy with defined endpointStandardized Use of Sedation Assessment Scales: •  Riker Sedation-Agitation Scale •  Richmond Agitation-Sedation Scale•  Motor Activity Assessment ScaleReferences:1.  Jackson, D., Proudfoot, C., Cann, K., Walsh, T. (2010). A systematic review of the impact of sedation practice in the ICU on resource use, costs, and patient safety. Critical Care, 14:R59.2.  Jacobi, J., Fraser, GL., Coursin, DB., et al.(2002).  Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med,  30:119-141.3.  Pun, B., Dunn, J. (2007). The sedation of critically ill adults. American Journal of Nursing, 107(7), 40-48.4.  Sessler, CN., Wilhelm, W. (2008). Analgesia and sedation in the intensive care unit: an overview of the issues. Critical Care, 12 Suppl 3:S1.of sedatives and analgesics in the critically ill adult. Crit Care Med,  30:119-141.

Sedation Safety Using Clinical Practice Guidelines

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Sedation Safety Using Clinical Practice Guidelines

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