title: Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery.
abstract: Pain and sedation protocols are suggested to improve the outcomes of patients within paediatric intensive care. However, it is not clear how protocols will influence practice within individual units.
  
  
  
  Evaluate a nurse led pain and sedation protocols impact on pain scoring and analgesic and sedative administration for post-operative cardiac patients within a paediatric intensive care unit.
  
  
  
  A retrospective chart review was performed on 100 patients admitted to a tertiary paediatric intensive care unit pre and post introduction of an analgesic and sedative protocol. Stata12 was used to perform Chi-squared or Student's t-test to compare data between the groups.
  
  
  
  Post protocol introduction documentation of pain assessments increased (pre protocol 3/24h vs post protocol 5/24h, p=0.006). Along with a reduction in administration of midazolam (57.6mcg/kg/min pre protocol vs 24.5mcg/kg/min post protocol, p=0.0001). Children's pain scores remained unchanged despite this change, with a trend towards more scores in the optimal range in the post protocol group (5 pre protocol vs 12 post protocol, p=0.06).
  
  
  
  Introducing a pain and sedation protocol changed bedside nurse practice in pain and sedation management. The protocol has enabled nurses to provide pain and sedation management in a consistent and timely manner and reduced the dose of midazolam required to maintain comfort according to the patients COMFORT B scores. Individual evaluation of practice change is recommended to units who implement nurse led analgesic and sedative protocols to monitor changes in practice.
authors.affiliation: Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia. Electronic address: grace.larson@rch.org.au.
authors.forename: Grace E
authors.initials: GE
authors.lastname: Larson
authors.affiliation: Department of Children's Nursing, London South Bank University, United Kingdom; Nursing Research Department, The Royal Children's Hospital, Melbourne, Australia; Department of Nursing, The University of Melbourne, Melbourne, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: McKeever
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000451:nursing*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D059408:Pain Management / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D014739:Victoria
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: Analgesia; Guideline; Intensive care; Paediatric; Protocol; Sedation