title: Sedative and analgesic use on night and day shifts in a pediatric cardiovascular intensive care unit.
abstract: BACKGROUND
  The use of sedative and analgesic medications is directly linked to patient outcomes. The practice of administering as-needed sedative or analgesic medications deserves further exploration. We hypothesized that important variations exist in the practice of administering as-needed medications in the intensive care unit (ICU). We aimed to determine the influence of time of day on the practice of administering as-needed sedative or analgesic medications to children in the ICU.
  
  
  METHODS
  Medication administration records of patients admitted to our pediatric cardiovascular ICU during a 4-month period were reviewed to determine the frequency and timing of as-needed medication usage by shift.
  
  
  RESULTS
  A total of 152 ICU admissions (1854 patient days) were reviewed. A significantly greater number of as-needed doses were administered during the night shift (fentanyl, P = .005; lorazepam, P = .03; midazolam, P = .0003; diphenhydramine, P = .0003; and chloral hydrate, P = .0006). These differences remained statistically significant after excluding doses given during the first 6 hours after cardiovascular surgery. Morphine administration was similar between shifts (P = .08).
  
  
  CONCLUSIONS
  We identified a pattern of increased administration of as-needed sedative or analgesic medications during nights. Further research is needed to identify the underlying causes of this practice variation.
authors.affiliation: Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children's Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 (sstaveski@lpch.org). Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Staveski
authors.forename: Tiffany M
authors.initials: TM
authors.lastname: Tesoro
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cisco
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D002648:Child; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015278:Intensive Care Units, Pediatric; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives