scholarly journals 1167 Nursing Perceptions of Sleep Assessment in the Intensive Care Unit

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A445-A446
Author(s):  
M S Heavner ◽  
S L Jobe ◽  
J Hurley ◽  
B Le ◽  
C Kantner ◽  
...  

Abstract Introduction Sleep disruption in intensive care unit (ICU) patients is highly prevalent and may contribute to adverse clinical outcomes. Although clinical practice guidelines recommend routine assessment of sleep, surveys of ICU clinicians indicate that sleep assessment programs (SAP) are rarely implemented. The purpose of the current project was to characterize sleep-related perceptions, practices, and knowledge among ICU nurses, to identify barriers and facilitators of implementation of a systematic SAP. Methods A 29-item, paper-based survey was administered to all nurses (N=220) in a medical ICU at a 750-bed academic medical center and a mixed ICU in a 300-bed community hospital. Voluntary survey completion was conducted over four weeks. Descriptive statistics were employed. Results A total of 163 surveys were completed (74.1%). Participants were primarily female (n=135; 82.8%), day-shift nurses (n=83; 50.9%), with 2-5 years of ICU experience (n=70; 42.9%). Respondents said they sometimes (n=52; 31.9%), and often (n=52; 31.9%), assess sleep, and 76.1% (n=124) reported not assessing sleep formally in the last three shifts. Approximately half of the respondents (n=85; 52.1%) were not aware of clinical practice guideline recommendations for sleep in the ICU. Most nurses reported that their unit could benefit from a SAP (n=101; 62.0%) and that they should have a primary responsibility in ensuring that sleep is discussed daily (n=144; 88.3%). Conclusion Despite published guidelines recommending routine sleep assessment, ICU nurses report infrequent assessment and a lack of awareness of these guidelines. However, ICU nurses believe implementation of routine sleep assessments would be beneficial to patient care. This suggests that SAP implementation would be positively received by ICU nurses. Future studies evaluating knowledge and site-specific perceptions and practices, as well as nursing staff characteristics, can further guide implementation of SAPs in the ICU. Support  

2021 ◽  
pp. 106002802110510
Author(s):  
Evan Atchley ◽  
Eljim Tesoro ◽  
Robert Meyer ◽  
Alexia Bauer ◽  
Mark Pulver ◽  
...  

Background Ketamine has seen increased use for sedation in the intensive care unit. In contrast to propofol or dexmedetomidine, ketamine may provide a positive effect on hemodynamics. Objective The objective of this study was to compare the development of clinically significant hypotension or bradycardia (ie, negative hemodynamic event) between critically ill adults receiving sedation with ketamine and either propofol or dexmedetomidine. Methods This was a retrospective cohort study of adults admitted to an intensive care unit at an academic medical center between January 2016 and January 2021. Results Patients in the ketamine group (n = 78) had significantly less clinically significant hypotension or bradycardia compared with those receiving propofol or dexmedetomidine (n = 156) (34.6% vs 63.5%; P < 0.001). Patients receiving ketamine also experienced smaller degree of hypotension observed by percent decrease in mean arterial pressure (25.3% [17.4] vs 33.8% [14.5]; P < 0.001) and absolute reduction in systolic blood pressure (26.5 [23.8] vs 42.0 [37.8] mm Hg; P < 0.001) and bradycardia (15.5 [24.3] vs 32.0 [23.0] reduction in beats per minute; P < 0.001). In multivariate logistic regression modeling, receipt of propofol or dexmedetomidine was the only independent predictor of a negative hemodynamic event (odds ratio [OR]: 3.3, 95% confidence interval [CI], 1.7 to 6.1; P < 0.001). Conclusion and Relevance Ketamine was associated with less clinically relevant hypotension or bradycardia when compared with propofol or dexmedetomidine, in addition to a smaller absolute decrease in hemodynamic parameters. The clinical significance of these findings requires further investigation.


2020 ◽  
Vol 40 (2) ◽  
pp. 14-23
Author(s):  
Stella Chiu Nguyen ◽  
Sukardi Suba ◽  
Xiao Hu ◽  
Michele M. Pelter

Background Patients with both true and false arrhythmia alarms pose a challenge because true alarms might be buried among a large number of false alarms, leading to missed true events. Objective To determine (1) the frequency of patients with both true and false arrhythmia alarms; (2) patient, clinical, and electrocardiographic characteristics associated with both true and false alarms; and (3) the frequency and types of true and false arrhythmia alarms. Methods This was a secondary analysis using data from an alarm study conducted at a tertiary academic medical center. Results Of 461 intensive care unit patients, 211 (46%) had no arrhythmia alarms, 12 (3%) had only true alarms, 167 (36%) had only false alarms, and 71 (15%) had both true and false alarms. Ventricular pacemaker, altered mental status, mechanical ventilation, and cardiac intensive care unit admission were present more often in patients with both true and false alarms than among other patients (P &lt; .001). Intensive care unit stays were longer in patients with only false alarms (mean [SD], 106 [162] hours) and those with both true and false alarms (mean [SD], 208 [333] hours) than in other patients. Accelerated ventricular rhythm was the most common alarm type (37%). Conclusions An awareness of factors associated with arrhythmia alarms might aid in developing solutions to decrease alarm fatigue. To improve detection of true alarms, further research is needed to build and test electrocardiographic algorithms that adjust for clinical and electrocardiographic characteristics associated with false alarms.


2018 ◽  
Vol 09 (02) ◽  
pp. 268-274 ◽  
Author(s):  
Christine Rehr ◽  
Adrian Wong ◽  
Diane Seger ◽  
David Bates

Objective This article aims to understand provider behavior around the use of the override reason “Inaccurate warning,” specifically whether it is an effective way of identifying unhelpful medication alerts. Materials and Methods We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug–drug interactions (DDI). Override appropriateness was analyzed by two independent reviewers using predetermined criteria. Results A total of 268 of 26,501 ICU overrides (1.0%) used the reason “Inaccurate warning,” with 93 of these overrides associated with our included alert types. Sixty-one of these overrides (66%) were identified to be appropriate. Twenty-one of 30 (70%) dose alert overrides were appropriate. Forty of 48 drug-allergy alert overrides (83%) were appropriate, for reasons ranging from prior tolerance (n = 30) to inaccurate ingredient matches (n = 5). None of the 15 DDI overrides were appropriate. Conclusion The “Inaccurate warning” reason was selectively used by a small proportion of providers and overrides using this reason identified important opportunities to reduce excess alerts. Potential opportunities include improved evaluation of dosing mechanisms based on patient characteristics, inclusion of institutional dosing protocols to alert logic, and evaluation of a patient's prior tolerance to a medication that they have a documented allergy for. This resource is not yet routinely used for alert tailoring at our institution but may prove to be a valuable resource to evaluate available alerts.


Sign in / Sign up

Export Citation Format

Share Document