Doctor of Nursing Practice Program

Raquel Ramirez Rovira, DNP, MSN, RN, AGACNP-BC

Raquel Ramirez Rovira
  • Committee Chair Name & Credentials:
    Natasha McClure, DNP, RN CPNP


DNP Project Abstract

Sedation Safety in the Intensive Care Unit (ICU)

The purpose of this project was to assess bedside nurses’ perceieved and actual barriers to titrating sedation medications to meet sedation goal ordered by the providers in the intensive care unit (ICU) at Monument Health.

Baseline data was collected by manual audit of 10 patient charts throughout a 24 hour period to determine if the ordered Richmond Agitation Sedation Scale (RASS) matched the documented RASS. Then, 115 bedside nurses working in the ICU were surveyed using a 23-question paper survey administered in person. 100% of nurses approached about the survey, volunteered to take it, and completed all 23 questions. The questions were a mix of open ended questions with some questions using a Likert scale.

Results were analyzed and common themes were identified. The final step of this project after major themes were identified was to address the perceived barriers by providing education or implementing other interventions needed to better support the bedside nurses in titrating sedation according to provider orders.

2/10 patients audited were sedated per order for the full 24 hours and no sedation titration took place to meet the patient’s RASS goal 69% of the time.

Nine themes were identified through survey analysis. The most frequent perceived barrier was “unsafe/unrealistic goal to sedating patients per ordered goal,” (n=22). The second and third most frequently reported barrier were: lack of nursing experience (n=18) and the patient population/diagnosis of the patient (n=18). Contradictory provider orders (n=16), where one sedation goal is identified by one provider team (i.e neurosurgery) and a different one is identified by another provider team (i.e the ICU team) was reported by from another provider team (i.e the ICU team).

Other barriers identified were unstable vital signs (n=12), inappropriate sedative medication ordered (n=11), laziness (n=10), lack of charting (n=4), and the ICU environment (n=4).

Implications for Practice
Limitations: Further investigation should be done to address why the nurses feel as if the ordered sedation goal is not appropriate for the patient, as it is not clear based on the survey alone.

Barriers identified can be addressed to minimize the number of medication errors relate to sedation in the ICU and increase the number of patients sedated to their ordered sedation goal from 20% to 100%. If medication errors are reduced, the ICU length of stay could potentially also be decreased, saving the hospital and ICU team money and improving patient outcomes.

Both primary and consulting providers need to work on their communication with each other to avoid giving nurses contradictory orders. Finally, education can be provided to ICU nurses to address the issues of list the survey items that you associate with this as how to treat unstable vital signs without the use of sedation.