The development of an early extubation algorithm for patients after cardiac surgery.

Changes in the way health care services are being reimbursed have resulted in the need to streamline care for patients who have undergone cardiac surgery, while preserving quality and positive outcomes. One method for reducing length of stay and overall cost of care is to adopt an early extubation program. The purpose of this article is twofold: (1) To share the process by which one hospital successfully initiated an early extubation program for their patients who had undergone cardiac surgery, and (2) To share the extubation algorithm, which is the tool designed by the health care team to guide the nursing and respiratory therapy staff members through the multiple steps and decision making points on the way to safe and timely extubation of the patient after cardiac surgery.

Analgesics for cardiac surgery patients in critical care: describing current practice.

BACKGROUND: In the last 10 years, the American Association of Critical-Care Nurses has twice ranked pain management as a priority issue for research and practice. Recent research findings suggest that undermedication of patients continues both in and out of critical care. Postoperative cardiac surgery patients have reported detailed recollections of pain experiences while in critical care, yet little is known about management of postoperative cardiac surgery pain. OBJECTIVE: The purpose of this study was to describe current practice related to analgesic prescription and administration for postoperative cardiac surgery patients in critical care. METHODS: Medical records of 80 adults undergoing cardiac surgery in two hospitals were randomly selected for review. Data pertaining to pain medications prescribed and doses administered for the day of surgery, first and second postoperative days were recorded for 66 eligible subjects. RESULTS: All but one patient had a prescription for intravenous morphine, hourly as needed. In addition, all patients had prescriptions for one or more oral analgesics as needed. Gender and age effects were noted for analgesic prescriptions. The average total amount of intravenous morphine given over the 3 days was 13.9 +/- 13.5 mg in an average of 4 +/- 3.7 doses. The average total number of acetaminophen with oxycodone tablets given over the 3 days was 5.8 +/- 5.4 tablets in an average of 3.6 +/- 3.0 doses. Age and hospital effects were noted in the administration of analgesics. CONCLUSIONS: The finding of small and infrequent analgesic doses is consistent with other studies conducted in and out of critical care. Important inconsistencies, or variations in practice, exist in both the prescription and administration of analgesics for postoperative cardiac surgery patients in the critical care setting.