Translation Of Evidence And Practice

Certified registered nurse anesthetists are advanced practice nurses who are certified and specialized in the administration of anesthesia (“Position description,” 2014). CRNAs make their own independent decisions and judgments regarding the application of anesthesia, and, in most states, physician supervision of CRNAs is not required (“Legal issues,” 2010). The profession was introduced to the United States during the

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.

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

In preparation of a review from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Nightingale Community Hospital will focus on improving its communication process in the operating room. The purpose of communication in the healthcare setting is to disseminate information in such a way as to create shared understanding about the patient and about what needs to be done for a positive outcome. (synergia.com) A patient is at his most vulnerable state during procedures that require sedation or anesthesia. The patient is releasing his decision making ability and safety into the control and care of the healthcare team. Therefore, effective communication on behalf of the patient is

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period?

To do so, I am going to use the fishbone diagram to categorize the causative factors (Potter & Perry, 2008).   For patient characteristics, Mr. B was a 67 year old patient with routine use of oxycodone to treat chronic pain.  Because of his routine use of oxycodone, he may need a different dose to get to a sedated level than other people who are not on any medication.  Next is the task factors, the hospital had a policy which requires that anyone who are treated with moderate sedation or analgesia have to be put on continuous blood pressure, ECG, and pulse oximeter monitoring until the procedure is done and patient is in stable condition.  Mr. B was not being monitored accordingly during the sedation process.  Another task factors is that all staffs must first complete a training module on sedation before performing the task.  Individual staff is a factor too, Nurse J had completed the training module on sedation, he had an ACLS certification as well as experience working as a critical care nurse.  Team factors include communication between staffs; an example would be the LPN not informing Nurse J or Dr. T when the alarm went off the first time, it showed that Mr. B had low oxygen saturation.  Work environment factors included the staffing in the ER, the equipments they had, and the level of experience of the staffs.  According to the scenario, additional staffs were available for back up support and all the equipment needed

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

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.

The authors recommend that the findings originating from this study can be used as a basis to initiate protocols for implementation of bedside nursing

Knowledge translation is a significant process in research studies or evidence based practice project implementation. This process relies on effective knowledge exchange and dissemination (Gaynon, 2009). According to Agency for Healthcare Research and Quality [AHRQ] (2012), propagation of evidence-based intervention necessitate overarching framework of communication tactics to guide this process, which include that the message targeting the primary audience segment, such as tailoring messages to individual level. This could be achieved through web-based communication, conferences, or prints to targeted individuals that enhanced behavior

Some people in the public, and especially RNs and nursing students, know exactly what a DNR is. They know that this means once a person experiences a cardiac and/or respiratory arrest, they are not to be resuscitated. In a policy from IU Health North Hospital (2016), the following treatments are to be withheld in the case of a respiratory and/or cardiac arrest when the patient has a signed DNR: chest compressions, start of ventilation support, endotracheal intubation, electrical countershock, cardiac pacing externally, and/or bolus administration containing antiarrhythmic, vasopressors, or inotropes. There is an exceptions section to the policy that states that “DNR orders are generally suspended in anesthetizing locations” (IU Health North Hospital, 2016, p. 4). It is noted that any existing directives need to be discussed with the patient when possible. It is important to view all aspects to this ethical issue to be able to see the entire picture of it. This includes looking at what is currently done, the opinions of patients and physicians, along with looking at policies from the American Society of Anesthesiologists along with the American College of Surgeons.

Procedural sedation course is very essential in health care settings because it helps health care workers to assist while administering sedations to patients who undergo procedure. Physicians, anesthesia technicians and nurses able to evaluate and monitor patient’s condition and dose of sedation with aid of this course, they learn and understand better about this topic. In other words, they gain knowledge that helps them in their daily routine task. Sedation is performed in all hospitals in procedural area. Millions of patients undergo procedures that require moderate or deep sedation each year. Over the past decades, the number of noninvasive procedures such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Electroencephalogram (EEG) and minimally invasive procedures such as lumbar puncture, endoscopy, biopsy and etc. have increased.

Although all levels of sedation are generally safe when practiced by qualified health practitioners on appropriately selected patients, serious adverse events during deep sedation may occur ranging from respiratory depression to laryngospasm, brain damage, and death. However, with proper monitoring, training of the clinician and staff, a suitable drug regimen, appropriate patient selection, and adherence to discharge criteria, serious adverse events are rare.1 Because oral sedation medications exhibit varying half-lives, posttreatment monitoring time will vary with different drug regimens.1 For medications with long half-lives, not only may the patient take longer to reach his/her original baseline cognitive and physiologic levels, but these

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period?

Assessing, preventing and managing pain plays an important role in patients experiencing delirium, which in turn poor pain management can become a risk factor for many different other problems for the patient. Dealing with mechanically ventilated patients it can be difficult to assess a patients pain effectively, but using a proper pain assessment tool can be beneficial. Many also want to increase a patient’s sedation, but truly assessing a patient’s pain might be the problem. Using sedation on a patient that is mechanically ventilated can be necessary, but it is imperative to perform both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT) on every patient to maximize the potential for weaning a patient off the ventilator. The choice of Analgesia and Sedation can be assessed properly using the Richmond Agitation-Sedation Scale (RASS) and can decrease the chances of a patient becoming over sedated. Choosing between analgesia and sedation can affect the weaning process, length a patient is ventilated, and how long a patient is in the ICU and potentially developing delirium. Monitoring and Managing Delirium is so important because “up to 81% of mechanically ventilated