title: Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit.
abstract: Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful.
authors.affiliation: St. John Fisher College Wegmans School of Nursing, Rochester, New York (Ms Sacco); Villanova University, College of Nursing, Villanova, Pennsylvania (Ms Sacco); Adult Critical Care Nursing, University of Rochester Medical Center, Rochester, New York (Ms Sacco and Mr LaRiccia); and Kessler Family Burn/Trauma ICU, Rochester, New York (Mr LaRiccia).
authors.forename: Tara L
authors.initials: TL
authors.lastname: Sacco
authors.forename: Brenton
authors.initials: B
authors.lastname: LaRiccia
mesh_terms: D016292:Procedural Sedation / Q000592:standards*; D064648:Critical Care Nursing / Q000379:methods / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D007400:Interprofessional Relations; D008297:Male; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D014193:Trauma Centers