title: Emergency nurses practices in assessing and administering continuous intravenous sedation for critically ill adult patients: a retrospective record review'.
abstract: OBJECTIVE
  To generate an initial profile of emergency nurses' practices in and factors influencing the assessment and administration of continuous intravenous sedation and analgesia for critically ill mechanically ventilated adult patients.
  
  
  BACKGROUND
  Emergency nurses are relied upon to assess and manage critically ill patients, some of whom require continuous intravenous sedation. Balancing sedation is a highly complex activity. There is however little evidence relating to how emergency nurses manage continuous intravenous analgesia and sedation for the critically ill intubated patients.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  A 12-month retrospective medical record review was undertaken from January to December 2009 of patients (>16 years) administered continuous intravenous sedation in ED.
  
  
  RESULTS
  Fifty-five patients received ongoing intravenous sedation within the ED during a median length of stay of 3.4 h. Assessment of patient depth/quality of sedation and pain-relief varied and were rarely documented. Adverse events were documented, majority (16%) drug administration related. Thematic analysis identified three themes: 'Maintaining sedation', 'Directionless-directions', and 'Navigating the balance'.
  
  
  CONCLUSIONS
  Emergency nurses provide continuity of patient care and optimisation of analgesia and sedation for critically ill sedated patients. The safety and effectiveness of continuous intravenous sedation for the critically ill adult patient in ED are dependent on the expertise and decision-making abilities of the nurse.
authors.affiliation: Prince of Wales Hospital Emergency Department, Faculty of Health, University of Technology, Sydney, Australia. Electronic address: wayne.varndell@sesiahs.health.nsw.gov.au.
authors.forename: Wayne
authors.initials: W
authors.lastname: Varndell
authors.affiliation: Faculty of Health, University of Technology, Sydney, Australia.
authors.forename: Doug
authors.initials: D
authors.lastname: Elliott
authors.affiliation: Faculty of Health, University of Technology, Sydney, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods; D016638:Critical Illness / Q000451:nursing*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009726:Nurses; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
keywords: Emergency nurse; Sedation assessment