Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery.

Journal article


Larson, GE and McKeever, S (2017). Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery. Australian Critical Care. https://doi.org/10.1016/j.aucc.2017.02.001
AuthorsLarson, GE and McKeever, S
Abstract

BACKGROUND: Pain and sedation protocols are suggested to improve the outcomes of patients within paediatric intensive care. However, it is not clear how protocols will influence practice within individual units. OBJECTIVES: Evaluate a nurse led pain and sedation protocols impact on pain scoring and analgesic and sedative administration for post-operative cardiac patients within a paediatric intensive care unit. METHODS: A retrospective chart review was performed on 100 patients admitted to a tertiary paediatric intensive care unit pre and post introduction of an analgesic and sedative protocol. Stata12 was used to perform Chi 2 or student t tests to compare data between the groups. RESULTS: Post protocol introduction documentation of pain assessments increased (pre protocol 3/24h vs post protocol 5/24h, p=0.006). Along with a reduction in administration of midazolam (57.6mcg/kg/min pre protocol vs 24.5mcg/kg/min post protocol, p=0.0001). Children's pain scores remained unchanged despite this change, with a trend towards more scores in the optimal range in the post protocol group (5 pre protocol vs 12 post protocol, p=0.06). CONCLUSIONS: Introducing a pain and sedation protocol changed bedside nurse practice in pain and sedation management. The protocol has enabled nurses to provide pain and sedation management in a consistent and timely manner and reduced the dose of midazolam required to maintain comfort according to the patients COMFORT B scores. Individual evaluation of practice change is recommended to units who implement nurse led analgesic and sedative protocols to monitor changes in practice.

KeywordsAnalgesia; Guideline; Intensive care; Paediatric; Protocol; Sedation; 1110 Nursing; Nursing
Year2017
JournalAustralian Critical Care
PublisherElsevier
ISSN1036-7314
Digital Object Identifier (DOI)https://doi.org/10.1016/j.aucc.2017.02.001
Publication dates
Print09 Mar 2017
Publication process dates
Deposited05 Dec 2017
Accepted11 Feb 2017
Accepted author manuscript
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Open
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