The use of analgesics and sedatives in critically ill patients: physicians' orders versus medications administered.

OBJECTIVE

To examine the difference between the prescribed and actually administered dose of analgesic and sedative drugs in critically ill patients.

DESIGN

Prospective survey.

SETTING

University hospital surgical intensive care unit.

SUBJECTS

One hundred fifty consecutive adult patients admitted to a surgical intensive care unit over a 3-month period.

METHODS

Data were gathered on a daily basis. The sedation and analgesia given were compared with the daily physician orders.

RESULTS

Narcotics and benzodiazepines were most commonly used. On average only 22% to 52% of the mean ordered dose of intravenous and intramuscular morphine was actually administered. Larger doses of morphine were administered to intubated patients than to nonintubated ones. Patients receiving intravenous fentanyl infusions generally were administered more than the ordered dose. The actual and prescribed doses of epidural fentanyl were well matched. Midazolam was the most frequently prescribed benzodiazepine. Like morphine, the amount administered was below the maximum ordered by the physicians.

CONCLUSIONS

Physicians tended to write fairly nonspecific orders that were used by the nursing staff as very broad guidelines. A need exists to educate physicians as to what patients actually receive for sedation and analgesia and at the same time improve the dialogue between nurses and physicians as to what patients actually require.