skip to content
Dovepress - Open Access to Scientific and Medical Research
View our mobile site

8852

Evaluation of a local ICU sedation guideline on goal-directed administration of sedatives and analgesics

Original Research

(2516) Views  (805) Full article downloads

Authors: DeGrado JR, Anger KE, Szumita PM, Pierce CD, Massaro AF

Published Date May 2011 Volume 2011:4 Pages 127 - 134
DOI: http://dx.doi.org/10.2147/JPR.S18161

Jeremy R DeGrado1, Kevin E Anger1, Paul M Szumita1, Carol D Pierce2, Anthony F Massaro3
1Department of Pharmacy, 2Department of Nursing, 3Department of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USA

Purpose: Sedatives and analgesics are commonly used in mechanically ventilated patients in the intensive care unit. Sedation guidelines have been shown to improve sedation management as well as various patient outcomes. The main objective was to evaluate adherence to a sedation guideline with both sedative prescribing and documentation of Richmond Agitation-Sedation Scale (RASS) scores.
Methods: In a retrospective chart review, data was collected on 111 medical intensive care unit patients mechanically ventilated via endotracheal tube for 12 hours or greater at Brigham and Women's Hospital. Fifty-seven patients were evaluated pre-guideline implementation and 54 patients were evaluated post-guideline.
Results: Significant increases were seen in the post-guideline group in goal-directed sedation with a patient-specific RASS goal in the sedation order: 21.3 vs 85.4% (P < 0.001), and mean number of sedation assessments per 24 hours using the RASS: 4.7 vs 11.4 (P < 0.001). Similarly, this group experienced a higher percentage of RASS scores at their sedation goal: 31.4 vs 44.1% (P < 0.001). No difference was seen in other clinical endpoints.
Conclusion: Implementation and routine application of a hospital pain and sedation guideline was associated with significantly improved sedation metrics, such as goal-directed sedation, as well as frequency of sedation level assessment and documentation. An increase was observed in the time that post-guideline patients spent at or near their RASS goal.

Keywords: sedation, agitation, guideline, RASS, mechanically ventilated, intensive care unit






Readers of this article also read:

Evidence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations
Role of aliskiren in cardio-renal protection and use in hypertensives with multiple risk factors
In vitro screening and structural characterization of inhibitors of the S100B-p53 interaction
Acute pain management in children
Topical preparations for pain relief: efficacy and patient adherence
Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial
Tapentadol extended-release for treatment of chronic pain: a review
Primary care for diabetes mellitus: perspective from older patients
Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy
Efficacy profile of liposome bupivacaine, a novel formulation of bupivacaine for postsurgical analgesia