30.03.2021 Views

Nevada RNformation - March 2011

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

Page 8 • <strong>Nevada</strong> <strong>RNformation</strong> <strong>March</strong>, April, May 2021<br />

Research & EBP Corner<br />

Nursing Application of Light Sedation for Mechanically<br />

Ventilated Patients<br />

Mary Bondmass, Ph.D., RN, CNE<br />

This RNF feature presents abstracts of research and evidence-based practice (EBP)<br />

projects completed or spear-headed by nurses or student nurses in <strong>Nevada</strong>. The<br />

focus is on new evidence (i.e., research) or the translation of evidence (i.e., EBP) in<br />

Practice, Education, or Research. Submissions are welcome and will be reviewed by<br />

the RNF editorial board for publication; send your abstract submission in a similar<br />

format used below to mary.bondmass@unlv.edu<br />

Kelsey Swanson, DNP(c) University of <strong>Nevada</strong>, Reno<br />

Featured EBP in this edition is Kelsey Swanson’s DNP<br />

project. Kelsey has been a cardiac ICU nurse for five years.<br />

She is currently completing her DNP at Orvis School of<br />

Nursing at the University of <strong>Nevada</strong> Reno. Kelsey is in the<br />

Adult Gerontology Acute Care Nurse Practitioner Track and<br />

will be graduating in May. An abstract of her final project is<br />

below.<br />

Kelsey intends to pursue a career as a hospitalist NP.<br />

Background: Patients with acute respiratory failure are<br />

routinely cared for in intensive care units (ICUs). Decompensation in respiratory<br />

status can be related to a primary pulmonary etiology or secondary to another<br />

acute illness. Many of these patients require the use of a ventilator to maintain<br />

adequate oxygenation. Historically, the use of pharmacologic sedatives in intubated<br />

patients has been common practice. Growing evidence suggests that these<br />

medications extend intubation duration, hospital lengths of stay, delirium, and<br />

long-term cognitive and mood disorders (Peitz et al., 2013). Literature supports<br />

the use of analgosedation, which focuses on pain management before sedation in<br />

mechanically ventilated patients (Devlin et al., 2018).<br />

New research and literature are available that condones the use of lighter sedation<br />

of mechanically ventilated patients. Traditional sedation practices have been shown to<br />

be harmful to patients as they are linked to poor short-term and long-term patient<br />

LUNGS<br />

BURNING?<br />

IT’S YOUR<br />

VAPE.<br />

Text “Start My Quit” to 855-891-9989.<br />

Free, confidential help.<br />

Just for teens to quit vaping.<br />

This ad is supported by the <strong>Nevada</strong> State Department of Health and Human<br />

Services and the Washoe County Health District.<br />

outcomes. Intubation times and ICU length of stay are prolonged with heavy sedation<br />

(Treggiari et al., 2009). Heavy sedation puts patients at risk for further complications.<br />

Cognitive function and mood disorders can also be negatively impacted by deep<br />

sedation in mechanically ventilated patients (Treggiari et al., 2009).<br />

Purpose/Methods: This project aimed to advocate and collaborate on behalf of<br />

the nursing discipline in a quality improvement initiative. "Sedation Light" refers to<br />

medication changes to achieve the desired Richmond Agitation and Sedation Score<br />

(RASS) of -1 to +1, as well as the clinical challenges associated with this change.<br />

“Sedation Light” utilizes fentanyl, propofol, and dexmedetomidine. This project<br />

worked to improve nursing care and moral related to “Sedation Light." Specifically,<br />

his project aimed to work with an interdisciplinary team and implement evidencebased<br />

changes to improve nursing care related to "Sedation Light." This project<br />

provided support, education, and advocacy for nursing throughout this transition in<br />

sedation practices to change nursing culture.<br />

Adult learning theory (Knowles, 1973) and Kolcaba’s theory of comfort (Krinsky<br />

et al., 2014) guided this project's implementation.<br />

A special interest group of “Sedation Light Implementation Champions” (SLIC)<br />

was assembled under the DNP student's leadership. This group served as a resource<br />

for nursing staff and was available on most shifts. SLIC supported nursing staff<br />

during shift work and advocated for appropriate application of sedation light<br />

flow sheets compiled by pharmacy. SLIC was closely involved with education and<br />

supportive efforts for staff nurses.<br />

Education for nursing staff was a primary component of this DNP project.<br />

Education was key to nurse endorsement of reducing sedation in mechanically<br />

ventilated patients. Numerous forms of education were offered to allow nurses to<br />

choose which format is most beneficial to them. Presentations of analgosedation,<br />

pain and sedation assessment, and long-term effects of heavy sedation were<br />

presented in unit staff meetings. Pamphlets and tip sheets were created, and SLIC<br />

completed in-services. These individual or small group learning sessions allow for<br />

an intimate discussion of challenges specific to individual patients. Troubleshooting<br />

has been available through these in-services and can help make bedside nurses feel<br />

supported in their challenges.<br />

A unit reference binder for “Sedation Light” was also created. It contains<br />

several original studies for nurses curious about the efficacy of reduced sedation.<br />

This literature can often be difficult and lengthy to read. For that reason, there are<br />

condensed articles explaining the benefits of light sedation, easy-to-read PADIS<br />

guidelines, and copies of "Sedation Light" flowsheets. These quick references allow<br />

for prompt location of applicable information and return to regular nursing duties.<br />

Offering extensive studies and condensed tip sheets allow nurses to seek the level of<br />

knowledge they desire without overwhelming.<br />

Results: This project resulted in an order set that decreased variability in<br />

sedation drugs used. Implementing a facility-wide policy to support the efforts of<br />

"Sedation Light" was a primary objective of this DNP project, and this objective was<br />

accomplished. Qualitative data related to “Sedation Light” was collected during<br />

daily ventilator rounds. These data include Richmond Agitation and Sedation Score<br />

(RASS), standardized sedation awakening trials (SAT), spontaneous breathing trials<br />

(SBT), and mobility as it relates to sedation strategies. Early on in this project, in<br />

April 2019, all patients that qualified for a SAT had one done. In February 2020,<br />

79% of patients qualified for a SAT, and 74% completed them. In July 2020, 86%<br />

of patients were eligible for SAT, but only 74% had an SAT. From this data set, even<br />

fewer patients are having these SATs paired with an SBT. The best month of paired<br />

SAT and SBT performance is April of 2019, where 57% of eligible patients received<br />

an SAT and SBT.<br />

Conclusion/Implication for Practice: This project aimed to directly change<br />

nursing culture and implement scholarly literature and research into practice.<br />

Creating a culture change related to sedation levels in mechanically ventilated<br />

patients is invaluable for patient outcomes. The nursing discipline must realize its<br />

responsibility to evolve practice in the clinical setting. The nursing discipline has<br />

valuable input for quality improvement initiatives. Nurses should seek involvement<br />

in large practice changes, even when initiated by other disciplines. Interdisciplinary<br />

collaboration is key to organizational success and improved patient outcomes.<br />

Abbreviated References<br />

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande,<br />

P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C.,<br />

Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X.,<br />

Fraser, G. L., Harris, J. E., …, Alhazzani, W. (2018). Clinical practice guidelines for the<br />

prevention and management of pain, Agitation/Sedation, delirium, immobility, and<br />

sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873.<br />

doi:10.1097/CCM.0000000000003299<br />

Knowles, M. S. 1. (1973). The adult learner: A neglected species. Houston [Tex.]: Gulf Pub.<br />

Co.<br />

Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba's<br />

comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-150.<br />

doi:10.1016/j.apnr.2014.02.004<br />

Peitz, G. J., Balas, M. C., Olsen, K. M., Pun, B. T., & Ely, E. W. (2013). Top 10 myths<br />

regarding sedation and delirium in the ICU. Critical Care Medicine, 41(9 Suppl 1),<br />

S46-S56. doi:10.1097/CCM.0b013e3182a168f5<br />

Treggiari, M. M., Romand, J., Yanez, N. D., Deem, S. A., Goldberg, J., Hudson, L.,<br />

Heidegger, C., & Weiss, N. S. (2009). Randomized trial of light versus deep sedation<br />

on mental health after critical illness. Critical Care Medicine, 37(9), 2527-2534.<br />

doi:10.1097/CCM.0b013e3181a5689f

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!