A Study On Sedation Management

Critically ill patients that require mechanical ventilation are at risk of developing secondary infections that may increase length of stay and possibly even morbidity. This fragile patient population requires special attention and meticulous adherence to established nursing standards of care. These standards of care are founded on evidenced based practices. It is important that nurses receive education about why these standards are in place and what consequences can result due to not following the established care protocols.

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Lack of enough trained staff in conscious sedation available at the time of the procedure

Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Primary goals of conscious sedation include he alteration of mood, the maintenance of consciousness, cooperation, elevation of the pain threshold, a minor variation of vital signs, and the production of some degree

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and

Terminal weaning is when mechanical ventilation is discontinued for a patient expected to die without its support (Knight & Espinosa, 2010). One of the most common methods of discontinuation is through slowly reducing the fraction of inspired oxygen (Knight & Espinosa, 2010). Terminal extubation is the removal of the endotracheal tube, and this can be done “during or after a terminal weaning process” (Knight & Espinosa, 2010, p. 527). Removal of life-supporting interventions is the cause of most deaths in critical care units (Knight & Espinosa, 2010). Knight and Espinosa (2010) discussed palliative sedation and terminal weaning in the same chapter because the two topics go together.

In order to decrease the likelihood that such sentinel event will occur again, a change must be put into place. In this case, the change should involve the process in which conscious sedation is carried out as well as the knowledge of those providing care for those patients. The registered nurse in this case is most likely very good at her job, she probably felt that she had everything under control and has most likely provided conscious sedation many times in the past. As an experienced nurse, however, it is wise to understand that one should never become complacent and it is okay to ask for additional help, especially when a change in patient’s status can occur so quickly. And while this nurse is up to date on her sedation modules

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

Compliance data audit results for moderate sedation procedures from pre to post procedure uncover that most categories met the 90th percentile a majority of the time. This has a direct effect on the provision of care, treatment and services.

Delirium in the Intensive Care Unit (ICU) has become a genuine phenomenon and can be problematic for the patient and the staff caring for them. Delirium occurs when a patient is placed in an unfamiliar environment and has to endure the stress of not just the hospitalization but the stimuli of the environment, which can cause disturbances in consciousness. Patients can become confused, anxious, and agitated; making this difficult for the staff to correctly diagnosis and care for them. Sleep deprivation and environmental factors along with neurotransmitters are strongly related to the occurrence of ICU delirium. ICU staff needs to become more educated on prevention, detection, and proper treatment for the patient experiencing this

sedation have continuous BP, ECG, & Pox monitoring done. Nurse J. who was trained in the

WEEK 5 PICO(T) QUESTION 1Good Afternoon Class and Dr. Stephenson,In and out of the hospital high quality cardiopulmonary resuscitation (CPR) is crucial to survival of victims of cardiac arrest. This research topic will focus on implementation of in hospital chest compressions in CPR. It will be based on a comparison of the efficacy of manual compressions and automated chest compressions in relation to survival outcomes. The potential attributes and short comings related to manual and automated chest compression will be reviewed. Intensive care unit (ICU) nurses have to be prepared to implement CPR during a cardiac arrest code. In consideration that patients in the ICU are often only marginally stable it is important that ICU nurses are familiar with their patient’s recent and past medical histories.

The literature supported a positive impact on patient outcomes when sedation awakening trials (SAT) and spontaneous breathing trials (SBT) were coordinated (Klompas et al., 2015, Woien & Bjork, 2012, & Woien, Vaeroy, Aamodt, & Bjork, 2012). The literature also supported the compliance of the coordination was more predictable when the nursing division was provided with protocol education (Klompas et al., 2015, Woien & Bjork, 2012, & Woien, Vaeroy, Aamodt, & Bjork, 2012). The summation of findings indicates that when education was integrated with the research methods, the outcomes related to nursing compliance were consistent and led to the completion of best practices. Nursing education was a controlled variable in research that found a positive correlation with SAT and SBT and outcomes for patients. Additionally, research without this controlled variable found inconsistencies with the performance of SAT/SBT and related outcomes. As a result, the particular relationship between