scholarly journals Implementation of a sedation protocol: a quality improvement project to enhance sedation management in the paediatric intensive care unit

2022 ◽  
Vol 11 (1) ◽  
pp. e001501
Author(s):  
Tarek Hazwani ◽  
Arwa Al Ahmady ◽  
Yasser Kazzaz ◽  
Abeer Al Smari ◽  
Seham Al Enizy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Percentage Increase ◽  
Improvement Project ◽  
Mechanically Ventilated ◽  
Sedation Protocol ◽  
Paediatric Patients ◽  
Scale Scores ◽  
Adequate Sedation ◽  
And Control ◽  
Improvement Team

BackgroundProper sedation is integral to ensuring the safety and comfort of children on mechanical ventilation (MV). Sedation protocols help to achieve this goal and reduce the duration of MV. We have observed varied sedation approaches, sedation score targets and sedative use by our physicians, which were manifested as oversedation and undersedation with associated accidental extubation. Hence, we aimed to implement a standardised sedation protocol and assess its impact on mechanically ventilated paediatric patients.MethodsA multidisciplinary quality improvement team was formed to develop and implement a standardised sedation protocol for mechanically ventilated paediatric patients. COMFORT-Behaviour (COMFORT-B) Scale score was used to assess the sedation targets and define undersedation, oversedation or adequate sedation. Our goal was to achieve adequate sedation during 90% of the sedation period. Based on the model for improvement methodology, we used plan–do–study–act cycles to develop, test and implement the new sedation protocol.ResultsThere was an immediate percentage increase in COMFORT-B Scale scores within the target sedation level, which was associated with a gradual decrease in the need for intermittent sedation doses over sedation infusion in the preimplementation, improvement and control phases (6.3, 4.9 and 3.1 sedation doses/12 hours/patient, respectively) to achieve adequate sedation target.ConclusionsThe standardisation of sedation protocols was safe and efficient, and improved the sedation quality in mechanically ventilated paediatric patients.

scholarly journals Histology Slide Quality Improvement Project Utilizing DMAIC principle of Six Sigma Quality Improvement Methodology

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S111-S112
Author(s):  
Y Wang ◽  
A Loboda ◽  
M Chitsaz ◽  
S Ganesan
Keyword(s):  
Quality Improvement ◽  
Six Sigma ◽  
Business Processes ◽  
Endometrial Biopsy ◽  
Improvement Project ◽  
Histology Slide ◽  
Six Sigma Methodology ◽  
And Control

Abstract Introduction/Objective DMAIC (an acronym for Define, Measure, Analyze, Improve and Control) refers to a data- driven improvement cycle used for improving, optimizing, and stabilizing business processes and designs. Our goal was to utilize DMAIC principle of six sigma quality to improve histology slide quality. Methods/Case Report We “defined” the problem as suboptimal quality in endometrial biopsy slides (defects). Utilizing the DMAIC principle and adhering to a strict timeline, the defects found during baseline slide quality review were “measured” by linking the defects to specific histology competencies, which were addressed systematically for process improvement (PI). After PI, a follow up review (“improve” and “control” phases) was carried out to identify measurable outcomes as a testament to quality. Results (if a Case Study enter NA) During the problem “measurement” phase, the defects found in the baseline review of 175 slides were linked to four specific histology competencies (fixation, embedding, cutting, and staining). Processing was excluded as it is completely automated and standardized. Our analysis showed that 83.3 % of defects were linked to embedding (“tissue too dispersed”). As embedding competency depends on the size and nature of the tissue (e.g. mucus and blood admixed with tissue), grossing competency was also addressed along with embedding at the respective workstations. Recommendations were offered to the grosser, embedder, and cutter to reduce variables during the “improvement” phase. Follow up review was done on 196 slides. The number of defective slides decreased and the defects that linked to “tissue too dispersed” had an overall improvement of 91.3%. Once the PI is proven to be effective, in service to histotechnology personnel biannually were also offered during “control” phase. Conclusion We have demonstrated successful methods for improving histology slide quality utilizing DMAIC principle of quality improvement by six sigma methodology DMAIC principle can be creatively adapted in laboratory practice management to enhance quality.

scholarly journals A Quality Improvement Evaluation of a Primary As-Needed Light Sedation Protocol in Mechanically Ventilated Adults

2020 ◽  
Vol 2 (12) ◽  
pp. e0264
Author(s):  
Lara M. Groetzinger ◽  
Ryan M. Rivosecchi ◽  
Bryan J. McVerry ◽  
Pamela L. Smithburger ◽  
Phillip E. Lamberty ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mechanically Ventilated ◽  
Sedation Protocol ◽  
Light Sedation

scholarly journals Effect of Clinical Opiate Withdrawal Scale Educational Intervention on Intensive Care Unite Nurses' Knowledge and Confidence

2021 ◽  
Author(s):  
Lauren Schneider
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Educational Intervention ◽  
The United States ◽  
Opioid Withdrawal ◽  
Quality Improvement Project ◽  
World Health ◽  
Opiate Withdrawal ◽  
Percentage Increase ◽  
Improvement Project

The opioid epidemic is a significant concern for the United States. Forty-eight and a half million Americans have either used illicit drugs such as heroin or have misused prescription opioid drugs. The exponential rise in opioid use increases the risk of opioid withdrawal, thus making opioid withdrawal assessment a top priority, especially for hospitalized individuals. The Clinical Opiate Withdrawal scale (COWS) is highly recommended to assess opioid withdrawal in hospitalized individuals and is well supported by the American Society of Addiction Medicine National Practice guideline and the World Health Organization. Despite the availability of reliable opioid withdrawal assessment scales, improper use and underuse of these scales are reported. Nurses education on the use of the COWS could address this gap. The purpose of this quality improvement project was to determine the effectiveness of an educational intervention concentrating on the COWS to improve critical care nurse’s knowledge and confidence in scale use. The quality improvement project utilized a pre-test, educational intervention and a posttest design. Twenty-eight out of the possible 60 critical care nurses participated in the quality improvement session. The mean scores on the pretest and post-test were 41.2 % and 83.5%, respectively. This showed a percentage increase in knowledge of 42.3. Furthermore, participants reported higher level of confidence in their ability to utilize the COWS. Receipt of COWS education could promote proper use of the scale. The advanced practice nurse can assist in establishing and implementing educational programs that focus on the importance of opioid withdrawal assessment through evidence-based practice.

scholarly journals Safety and Utility of Continuous Ketamine Infusion for Sedation in Mechanically Ventilated Pediatric Patients

2018 ◽  
Vol 23 (6) ◽  
pp. 447-454
Author(s):  
Amy L. Heiberger ◽  
Surachat Ngorsuraches ◽  
Gokhan Olgun ◽  
Lisa Luze ◽  
Caitlin Leimbach ◽  
...  
Keyword(s):  
Adverse Events ◽  
Continuous Infusion ◽  
Pediatric Patients ◽  
Average Rate ◽  
Pediatric Intensive Care ◽  
Mechanically Ventilated ◽  
Ketamine Infusion ◽  
Sedation Protocol ◽  
Before And After ◽  
Adequate Sedation

OBJECTIVES The selection of sedative medications for mechanically ventilated pediatric patients remains an ongoing clinical challenge. Although continuous ketamine infusion has been used in this population, support for its use remains largely anecdotal. This study describes a single institution's use of ketamine infusions as part of a sedation protocol in the pediatric intensive care unit (PICU). METHODS This was a retrospective study of children who received ketamine infusions as part of a multidrug sedation protocol in a 12-bed PICU at a tertiary children's hospital. Outcomes included effectiveness of ketamine infusion in providing adequate sedation as determined by State Behavioral Scale (SBS) scores and incidence of adverse events. RESULTS A total of 22 children receiving ketamine continuous infusion as part of a multidrug sedation protocol from February 2014 through October 2015 were eligible and enrolled in the study. Ketamine continuous infusion was administered in addition to at least 2 other sedation infusions at an average rate of 1.02 ± 0.50 mg/kg/hr, with a range of 0.07 to 2.0 mg/kg/hr. The duration of ketamine was 65.7 ± 41.01 hours, with a range of 19 to 153 hours. There was no significant change in SBS scores before and after initiation of ketamine infusion. Although not statistically significant, patients with inadequate sedation prior to starting ketamine required fewer bolus sedation doses and had improved sedation after ketamine was started. There were no reported adverse events. CONCLUSIONS The addition of a ketamine infusion as part of a multidrug sedation regimen was at least as effective as patients' regimen prior to ketamine addition in this population of intubated pediatric patients, with no adverse events.

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