Sedation interruption is a significant nursing practice issue especially with the changing hospital reimbursement of nosocomial complications. Nurses are at the heart of practice change and, therefore, assessment of nursing practice and underlying reasoning related to lack of compliance of hospital-initiated nursing protocols. These protocols are important to evaluate when collaborating care among the multidisciplinary team and, ultimately, to design subsequent educational initiatives. Sedation is defined as an induced state of quiet, calm, or sleep by means of medication and is used often in the critically ill patient.1 The intensive care unit (ICU) patient requires sedation to ease discomfort with invasive procedures, reduce anxiety, improve tolerance of mechanical ventilation, promote patient rest and healing, and facilitate nursing care.

PURPOSE

The purposes of this study were to (1) examine the nursing knowledge of sedation interruption protocol and criteria for interruption and (2) identify reasons for divergence between nursing practice and standing protocols among nurses.

DESIGN

This study consisted of a descriptive research involving an anonymous survey of day and evening nurses.

SETTING

The study focused on a surgical ICU (SICU) of a level 1 trauma hospital in New York. Data were collected over a 2-week period.

MATERIALS AND METHODS

A 5-question open-ended survey was completed by 18 of 22 (82%) SICU nurses working day and evening shifts.

FINDINGS

Most of the reasons cited for nursing reluctance in following the sedation interruption protocol related to the patient's hemodynamic or ventilation instability (37.5%) and patients being combative or agitated (33.3%). Both reasons are exclusion criteria in the protocol and assessment, revealing an educational need for clarification of the protocol and assessment. The nurses offered several recommendations for modifying the protocol, particularly to the desire for daily physician assessment and resulting individual patient orders versus nurse initiation, as well as clarification of the protocol criteria (25%).

INTERVENTIONS

Based on the data collected, an educational in-service was designed for the SICU nursing staff. All staff on the unit were invited to the educational program. The in-service tri-fold poster included an introduction to the components of the ventilator-acquired pneumonia bundle, the benefits to sedation interruption, drawbacks to continuous infusion, drug accumulation/prolonged clearance, and prolonged recovery of mental status. The data collected based on the unit survey were displayed to provide the nurses with insights into their peers' responses. These data were provided along with the sedation interruption section of the protocol, and the ventilator-acquired pneumonia bundle section of the assessment was also highlighted.

CONCLUSIONS

It is evident in this research endeavor that there is a need for continuity of practice versus protocol to be met among the nursing administration, physicians, and nursing staff. However, it is also evident that part of the educational need stems from a lack of continuity between the exclusion criteria of the sedative interruption protocol, which may be considered by some nurses to be out of the nursing scope, as was clearly indicated by nursing staff who believed that a physician order must be in place. A physician order and nursing algorithm may lead to higher protocol compliance among nurses. Among the resources cited, it is clear that there is a gap in nurse-initiated research related to sedation interruption. Because the topic of sedation interruption still requires much in-depth research including aggregate study of the complications associated with the critically ill patient, there is a need for more nurse-initiated research. The ICU patient is most susceptible to quickly initiated interventions and, therefore, at risk for subsequent complications. Continuity between medical, administrative, and nursing initiatives is a challenge that must be addressed to bridge care and the educational gap between best practice and current theory.

Submitted by:

Alison Joseph-Belfort, BA, BS, RN

Albany, NY

mailto:[email protected]

Acknowledgments

Thank you to following people who provided me with encouragement and insight in preparing this manuscript Jessamyn Luke, RN, Tonya Zwirtz, MS, BS, RN and Elizabeth Mahoney, PhD, RN.

Reference