ICU Sedation Lightening Protocol Decreases Use of Sedatives for Ventilated Patients

Problem

  • While on a ventilator, patients in the ICU are often given Propofol or high dose Versed. These drugs cause prolonged sedation days and make it challenging for patients to recover from the sedative effects of the drugs.
  • Prolonged mechanical ventilation can subsequently lead to delirium and weakness.
  • The goal of the Sedation Lightening Protocol was to improve decrease the use of sedatives for ventilated patients.

Intervention

  • The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle incorporates the best available evidence related to delirium, immobility, sedation/analgesia, and ventilator management in the ICU that can be adopted into everyday clinical practice. The bundle was adopted by the American Association of Critical Care Nurses.
  • Kelly Brubakken, RN, BSN, CCRN, an ICU nurse and member of AACN. helped implement SMCA’s ICU Sedation Lightening Protocol over a period of several months.
  • The protocol was developed based on AACN recommendations in 2015 and extensive education for clinical nurses and staff began in January 2016.
  • The metric used to measure success was improvement in Richmond Agitation Sedation Scale (RASS) scores.
  • Kelly and the clinical ladder team also performed chart audits to ensure compliance to the guidelines and provided “real time” education and re-education to staff nurses as needed.

Results

  • After adopting the Sedation Lightening Protocol for ventilated patients, the ICU clinical nurses and staff were able to see an improvement for their ventilated patients.
  • With the implementation of the Sedation Lightening Protocol, nurses were able to readily assess appropriate medications could be used for patients based on their pain assessment and medicate per physician order.
  • With the use of the algorithm, nurses noticed patient were more awake and involved in their own plan of care. With improved levels of alertness rated on the RASS scale, weaning the patient from the ventilator became more feasible.

Overall, the team saw an improvement in the use of sedating medications on patients go from 79 percent optimal RASS score up to 89 percent optimal RASS score.