Samantha Green is a registered nurse in the medical intensive care unit at Ascension St. John Hospital, Detroit, Michigan.
Beth A. Staffileno is a professor in the College of Nursing and Co-Director for the Center for Clinical Research and Scholarship at Rush University Medical Center, Chicago, Illinois.
Crit Care Nurse. 2021 Dec 1;41(6):29-35. doi: 10.4037/ccn2021625.
In patients receiving mechanical ventilation, prolonged exposure to sedative and analgesic medications contributes to negative clinical outcomes.
To reduce exposure to sedative and analgesic medications among patients receiving mechanical ventilation by implementing a nurse-driven sedation protocol.
This quality improvement project followed a plan-do-study-act cycle. Nurses were educated on the protocol, and 30 patient medical records were reviewed both before and after protocol implementation. Data were extracted on intensive care unit length of stay, duration of mechanical ventilation, duration of continuous sedation, presence of delirium, pain, level of sedation, and performance and documentation of spontaneous awakening trials. Data were analyzed using descriptive statistics, the χ2 test, and calculated percent change.
Forty-four nurses completed protocol education. The mean (SD) duration of mechanical ventilation decreased by 26% (from 5 [3.7] days to 3.7 [3.2] days), and the mean (SD) intensive care unit length of stay decreased by 27% (from 6.3 [4.3] days to 4.6 [3.7] days). The mean (SD) duration of continuous sedation decreased by 35% (from 6419 [7241] minutes to 4178 [4507] minutes). Spontaneous awakening trials documented increased by 35% (from 57% to 77%), and spontaneous awakening trials performed increased by 92% (from 40% to 77%), a statistically significant change (P = .004).
These preliminary data suggest that implementation of a nurse-driven sedation protocol resulted in favorable outcomes by decreasing duration of mechanical ventilation, intensive care unit length of stay, and duration of continuous sedation and increasing the number of spontaneous awakening trials performed.
在接受机械通气的患者中，长时间使用镇静和镇痛药物会导致负面的临床结果。
通过实施护士主导的镇静方案来减少接受机械通气的患者接受镇静和镇痛药物的暴露。
本质量改进项目遵循计划-执行-研究-行动（Plan-Do-Study-Act）循环。对护士进行了方案教育，并在方案实施前后回顾了 30 份患者病历。提取了重症监护病房住院时间、机械通气时间、持续镇静时间、谵妄、疼痛、镇静水平以及自主唤醒试验的表现和记录的数据。使用描述性统计、χ2 检验和计算百分比变化进行数据分析。
44 名护士完成了方案教育。机械通气时间的平均（SD）减少了 26%（从 5[3.7]天减少到 3.7[3.2]天），重症监护病房住院时间的平均（SD）减少了 27%（从 6.3[4.3]天减少到 4.6[3.7]天）。持续镇静时间的平均（SD）减少了 35%（从 6419[7241]分钟减少到 4178[4507]分钟）。自主唤醒试验记录增加了 35%（从 57%增加到 77%），自主唤醒试验执行增加了 92%（从 40%增加到 77%），这是一个具有统计学意义的变化（P=0.004）。
这些初步数据表明，实施护士主导的镇静方案通过减少机械通气时间、重症监护病房住院时间和持续镇静时间以及增加自主唤醒试验的执行次数，产生了有利的结果。
