Formulation and implementation of analgesia and sedation management plan in pediatric patients with mechanical ventilation / 中国实用护理杂志

ABSTRACT

Objective To develop a nurse-driven analgesia and sedation management plan and determine whether the protocol leads positive results.Methods This was a before and after protocol implementation study in 2 pediatric intensive care units of 2 tertiary care hospitals.A total of 77 medical pediatric patients requiring mechanical ventilation with pediatric intensive care unit (PICU) length of stay for at least 24 h were included.Prior to implementation of the protocol,analgesia and sedation was managed by the attending physician's order.Afterwards,post implementation,nurses managed analgesia and sedation following the protocol,including maximum human care,complying the same sedation objective,ordination of the speed according to Comfort Scale and Withdrawal Assessment Tool.Results Before the implementation of protocol,the amount of murphy equivalent was (18.51 ± 13.34) mg/kg,the amount and time of Midazolam were (26.29 ± 13.58) mg/kg and (137.31 ± 104.78) h respectively,mechanical ventilation time was (174.00±90.17)h and time of PICU stay was (12.28 ± 8.86) d;after the implementation of protocol the indexes were (11.46 ± 15.97) mg/kg,(12.01 ± 10.06) mg/kg,(99.44 ±47.29) h,(111.15 ± 58.82) h,(10.88 ± 7.68) d,and there were significant differences (t=0.743-2.595,P＜0.05).The incidence of withdrawal after the implementation of protocol (19.44％,7/36) was significantly lower than that before the implementation of protocol (4.88％,2/41),and there was significant difference (x2=3.940,P＜ 0.05).The coincidence of sedation assessment of after the implementation of protocol was 93.33％ (126/135),that of before the implementation of protocol was 83.67％ (82/98),and there was significant difference (x2=5.532,P＜0.05).Conclusions The plan takes "early analgesia,minimizing sedation,maximizing human concern" as the guiding ideology,and strives to achieve the goal of sedation individualization,clarification of medical and nursing responsibilities,continuity of medical communication,standardization of drug selection and regulation,routinization of withdrawal procedures,routinization of evaluation records,and the management of analgesia and sedation is included in the department.In the key projects of nursing quality management,we should institutionalize the implementation process management.The implementation of the program improves the comfort level of children,thus reducing the stress state of children,reducing the incidence of withdrawal symptoms and unplanned extubation,and ultimately reducing drug consumption and mechanical ventilation time.