Miscommunication In ICU Patients
The acuity of patients in the intensive care unit (ICU) regularly requires extensive measures to provide necessary life supporting care. Very often this includes the need of mechanical ventilation. For obvious reasons, patients that require mechanical ventilation experience agitation and apprehension; because of this, these patients commonly need to be sedated. For many years different methods of sedation have been tried, such as intermittent boluses that may lead to indiscriminate arousal of the patient and less control of their agitation. Of late, a recent study has concluded, half of ICU patients are now given a continuous drip of some sort. Frequently it is of a benzodiazepine and propofol. The benefit of a continuous infusion is the decreased
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For instance, it is correlated to longer ICU hospitalizations, the need for extended mechanical ventilation and the tendency to become oversedated. Despite of these weaknesses the popularity of using continuous sedation has continued to grow as years have passed. As this process has evolved, to reduce these shortcomings careful administration of these medications must be followed and titration, whether up or down, is necessary and based on a thorough nursing assessment. One such tool to assess the sedated patient is the Richmond agitation sedation scale (RASS) which uses a ten point scale to score the patients level of consciousness (LOS). The RASS’ has scores ranging from +4 (combative) thru -5 (unarousable), the goal for the patient is to remain somewhere between -1 and -3. Their respective descriptions are -1 being DROWSY, -2 LIGHT SEDATION and -3 MODERATE SEDATION. Healthcare institutions often have a protocol on how to titrate the combination of sedative medications based on these scores with the overall goal to being the lowest level of sedation to provide the least amount of agitation while using the lowest necessary concentration of sedative drugs. Research and evidence based practice has shown that utilizing this tool has produced positive patient results. Also, along with the RASS technique there is another practice worth noting that has gained wide acceptance in how to lessen the severity of the above mentioned deficiencies of continuous
For instance, it is correlated to longer ICU hospitalizations, the need for extended mechanical ventilation and the tendency to become oversedated. Despite of these weaknesses the popularity of using continuous sedation has continued to grow as years have passed. As this process has evolved, to reduce these shortcomings careful administration of these medications must be followed and titration, whether up or down, is necessary and based on a thorough nursing assessment. One such tool to assess the sedated patient is the Richmond agitation sedation scale (RASS) which uses a ten point scale to score the patients level of consciousness (LOS). The RASS’ has scores ranging from +4 (combative) thru -5 (unarousable), the goal for the patient is to remain somewhere between -1 and -3. Their respective descriptions are -1 being DROWSY, -2 LIGHT SEDATION and -3 MODERATE SEDATION. Healthcare institutions often have a protocol on how to titrate the combination of sedative medications based on these scores with the overall goal to being the lowest level of sedation to provide the least amount of agitation while using the lowest necessary concentration of sedative drugs. Research and evidence based practice has shown that utilizing this tool has produced positive patient results. Also, along with the RASS technique there is another practice worth noting that has gained wide acceptance in how to lessen the severity of the above mentioned deficiencies of continuous