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Text. Multidisciplinary Approach to Sedation Goals and Treatment Algorithms to Treat Pain & Sedation Needs of PCTU Patients Connie Myres RN, MSN, CCRN & Sandra Merkel, MS, RN- BC Regine L. Caruthers, Pharm.D . & Robert Gajarski Jr, MD. Purpose. Discussion. Methods.

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Multidisciplinary Approach to Sedation Goals and Treatment Algorithms to Treat Pain & Sedation Needs of PCTU Patients

Connie Myres RN, MSN, CCRN & Sandra Merkel, MS, RN-BC

RegineL. Caruthers, Pharm.D. & Robert GajarskiJr, MD

Purpose

Discussion

Methods

PRE-IMPLIMENTATIN SURVEY: Nurses, physicians, and nurse practitioners were surveyed prior to implementation of the project to evaluate their level of comfort and feelings of success in treating pain, managing sedation, agitation and withdrawal in the PCTU patient population in March 2010

POST-IMPLIMENTATION SURVEY: Surveys were given to RN’s & NP’s who were on the unit prior to the roll out of the program. The roll out occurred over 18 months.

EDUCATION MODULE: An education module provided by the pediatric pain service with CE’s was given to the RN’s in June of 2010.

SEDATION GOALS: Implementation of sedation goals with education to nursing and physicians at rounds to establish a common language to describe the patient’s pain and sedation needs March 2010.

PAIN & SEDATION TREATMENT ALGORITHMS: Once this has been accomplished pharmacy and physicians incorporated pain and sedation algorithms to provide more consistent approach to the management and allow nursing to have more autonomy to provide care in Feb 2011. (see example below)

Survey:Likert type survey developed by the Pediatric Pain Service and adapted for use in the PCTU.

Conclusion

  • Of the nurses surveyed, 80% have been ICU nurses greater than 6 years. This demonstrates that experienced nurses perceived benefits to their skills related to pain, agitation, sedation, and withdrawal.
  • The assessment and treatment of agitation and withdrawal continue to be areas the PCTU nurses want to be more proficient at.

Background

While pain was consistently assessed in the PCTU as evidenced by our 100% compliance with this nursing quality indicator for 2010, it was evident that patients were receiving different treatments based on caregiver characteristics instead of patient assessment data in some cases. Work was being done in silos by physicians, pharmacy and nursing.

Formation of a multidisciplinary group, along with support from the pediatric pain service, worked to break down the silos and barriers to care providers using the same language to describe pain and sedation in the PCTU. The creation of order sets for sedation goals was implemented in October 2010 and order sets for the medication algorithms were implemented in February 2011.

Results

References

Deeter K. & King M et al. Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Critical Care Medicine 2011; 39 (4): 683-688.

Franck L, & Harris S, et al. The Withdrawal Assessment Tool–1 (WAT–1): An assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatric Critical Care Medicine 2008; 9 (6): 573-580.

Malviya, S. Voepel-Lewis, T. Burke, C. Merkel, S. & Tait, A. (2006). The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia, 16, 258-265.

Malviya S, Voepel-Lewis T, Merkel S et al. Difficult pain assessment and lack of clinician knowledge are ongoing barriers to effective pain management in children with cognitive impairment. Acute Pain 2005; 7: 27–32.

Voepel-Lewis T, Merkel S, Tait AR et al. The reliability and validity of the face, legs, activity, cry, consolabilityobservational tool as a measure of pain in children with cognitive impairment. AnesthAnalg 2002; 95: 1224–1229.

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