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.
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
PublisherLondon South Bank University
ISSN1036-7314
Digital Object Identifier (DOI)doi:10.1016/j.aucc.2017.02.001
Publication dates
Print09 Mar 2017
Publication process dates
Deposited05 Dec 2017
Accepted11 Feb 2017
Accepted author manuscript
License
CC BY-NC-ND 4.0
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https://openresearch.lsbu.ac.uk/item/87015

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