Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Melissa Davis, DNP, CNM, FNP-BC, FACNM, C-EFM
• Committee Member Name & Credentials:
  Michelle Terrell, DNP, CPNP-AC

DNP Project Abstract

The Implementation of Evidence Based Practice Guidelines for Sedation Management in the Pediatric Intensive Care Unit

Purpose
Current pediatric critical care recommendations suggest that the implementation of unit specific goal directed sedation titration may decrease sedation exposure for pediatric patients as well as increase staff satisfaction.  The purpose of this quality improvement project was to develop a set of sedation titration guidelines to streamline sedation practice and improve nursing satisfaction with patient sedation management in a high acuity 28 bed mixed medical and cardiac PICU.

Methods
A set of evidence-based sedation titration guidelines were developed by a multi-disciplinary PICU team.  Prior to implementation, a survey on nursing perception of current sedation practice was emailed to all PICU nurses.  Education sessions were provided for all participants prior to project implementation.  Compliance data was collected during the initial six-week implementation period to ensure implementation by all staff.

Results
A total of 39 out of 100 registered nurses completed the sedation satisfaction survey for a response rate of 39%.   The majority of nurses surveyed felt that provider variation was the largest barrier to sedation management on our unit (62%, n=24).  90% of respondents felt strongly that caring for a patient that was not adequately sedated affected their job satisfaction.  At the start of the observation period, less than half of patients had an appropriate sedation scores ordered, despite that having been the practice on the unit prior to the project.  This improved to 100% by the conclusion of the initial 6-week period.  The guidelines also recommended that bolus doses of sedation were equivalent to the drip rate, which was a new practice for our providers.  The compliance for dosing was 0% for the first two weeks but improved to 78% by the end of the initial 6-week implementation period.

Implications for Practice
Job satisfaction of nurses in our PICU is affected by their patient’s level of sedation, as well as their perception of how well providers listen to their concerns.  Sedation guidelines may help to increase nursing autonomy by providing clear parameters for contacting providers regarding sedation related concerns.  Additional PDSA cycles are required to determine whether the total exposure to sedation agents also occurs when multi-disciplinary guidelines are in place.