Monday, May 08, 2006

St. Joseph Hospital Evidence Based Nursing Practice (cont'd)

Sedation Management and weaning to facilitate extubation in the ICU

Investigator: Victoria Randazzo, RN, BSN, CCRN

Purpose: This multidisiplinary team is looking at the comprehensive way in which sedation (Benzodiazepines, Propofol) is managed in the intubated ICU patient. The intent is to promote a recognition of the ability to wean by using a daily "sedation vacation". The process utilizes a team approach between the staff nurse, the respiratory therapist and the Intensivist. This evidence based practice focuses on reducing ventilator associated pneumonia, shorter patient stays, reduced costs and better patient outcomes.
In addition to tracking patient outcomes, the process involves staff education which is facilitated by the team's ten member nursing staff and the clinical educator. Dr. Duke, one of the physician Intensivists, is offering the ICU staff a class titled "Sedation/Agitation in the Mechanically Ventilated Patient".


Dana Rutledge said...

Are there any clinical practice guidelines for sedation protocols for ventilated patients? For neuro patients?

Judy Rousch, RN, BSN said...

The National Guideline Clearinghouse (NGC) is a public resource for EB clinical practice guidelines and does list "Clinical practice guidelines for the sustained use of sedation and analgesia in the critically ill adult." The Institute for Healthcare Improvement (IHI), which promotes the use of EB practice, lists the implimentation of "Ventilator Bundle" of which "sedation vacation" and "assessment of readiness to extubate" is a part of a daily process check.
In the January 2006 issue of Nursing Standard, Christine Meumarch alludes to the fact that the there is a lot of research on this topic. However there are also difficulties in establishing protocols because of the complexity of the patient's condition and the fact that clinical judgement may override the protocol.
We did not address the issues of the neurological patient as a separate entity. But it seems you would want to use a drug that would allow you to quickly wean to assess their neuro status. What about "Phenobarb Coma"?