Alexander Eren, Carnevale Franco A, Razack Saleem
Montreal Children's Hospital, 2300 Tupper, Montreal, Que., Canada HH IP3.
Intensive Crit Care Nurs. 2002 Oct;18(5):292-301. doi: 10.1016/s0964339702000502.
The aim of this study was to conduct an evaluation of a sedation protocol that transfers some decision-making authority for analgesia and sedation, within clearly defined parameters, to nurses in a pediatric intensive care unit (PICU). The sedation protocol used in this study was appropriate for any age group. The clinical course of 10 patients admitted to the PICU during a 5-month interval who were on the sedation protocol during their stay was examined using retrospective chart review. Time intervals when patients were on the protocol were compared with clinically comparable time intervals, in terms of acuity, when the same patient received conventional management. Data were collected on the number of days a child was ventilated, the number of days in the PICU, the number of days hospitalized and severity of illness. Additionally, data were collected on the amounts of sedation and analgesia required and the incidence of under-sedation. Physician and nurse satisfaction with the sedation protocol was examined using a self-report survey. The findings of this study indicate that the delegation of decision-making authority for analgesia and sedation to PICU nurses can provide effective and timely management of patient comfort, without an increase in morbidity, in a manner that is more satisfying for physicians and nurses.
本研究的目的是对一种镇静方案进行评估，该方案在明确界定的参数范围内，将部分镇痛和镇静的决策权下放给儿科重症监护病房（PICU）的护士。本研究中使用的镇静方案适用于任何年龄组。通过回顾性病历审查，对在5个月期间入住PICU且住院期间采用该镇静方案的10例患者的临床病程进行了检查。将患者采用该方案的时间段与同一患者接受传统管理时在病情严重程度方面具有临床可比性的时间段进行比较。收集了儿童机械通气天数、在PICU的天数、住院天数以及疾病严重程度的数据。此外，还收集了所需镇静和镇痛的剂量以及镇静不足的发生率的数据。使用自我报告调查来考察医生和护士对该镇静方案的满意度。本研究结果表明，将镇痛和镇静的决策权下放给PICU护士，能够以一种让医生和护士更满意的方式，在不增加发病率的情况下，有效且及时地管理患者的舒适度。
