title: A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.
abstract: BACKGROUND
  Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas.
  
  
  METHODS
  The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants.
  
  
  RESULTS
  Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain.
  
  
  CONCLUSIONS
  The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.
authors.affiliation: Medical Intensive Care Unit, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania 19141-3211, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Arbour
mesh_terms: D000698:Analgesia; D000700:Analgesics / Q000008:administration & dosage*; D016292:Procedural Sedation; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007318:Inservice Training / Q000458:organization & administration*; D008991:Monitoring, Physiologic; D020380:Needs Assessment; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D011785:Quality Assurance, Health Care
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents