Sedation Pathway Utilizing COMFORT B scale for Intubated PICU Patients
No Thumbnail Available
Authors
Moe, Shelby
Issue Date
2023-05-11
Volume
Issue
Type
Manuscript
Language
Keywords
Alternative Title
Abstract
Purpose: This project developed an evidence-based sedation pathway specific to a single PICU to optimize the use of the COMFORT B assessment tool and improve communication on sedation strategies for intubated patients in the PICU
Background: Sedation assessment tools like COMFORT B are used by PICUs to provide objective measurement to sedation. Sedation pathways address aspects of the liberation bundle to reduce acquired comorbidities like adequate sedation, delirium, withdrawal, promoting early mobility, and family engagement.
Sample/Setting: During a 6-week period in a 12 bed PICU, intubated patient who met inclusion criteria used the COMFORT B pathway to titrate sedation towards an ordered goal.
Methods: Intubated patients who didn’t meet exclusion criteria used the pathway. The providers used a smart text phrase and ordered goal sedation. The sedation pathway included two separate, color-coded pathways for the nurse and provider. Role-specific guidance on management for patients based on their COMFORT B and NISS scores was compared to ordered goal.
Results: The data collected focused on COMFORT B quality as compared to ordered goal sedation. Over 6 weeks, 11 patients (mean age of 17.9 months) with a total intubation days of 88 (mean of 8 intubated days per patient) were included. COMFORT B scores were recorded 70% of the time with a score range of (8 to 27). Providers utilized the smart text phrase in the daily progress note 90% of the time 23% of the time no daily range documented while the patient care order of goal sedation was utilized 85% of the time.
Conclusion: High compliance (70% smart text phrase and 85% ordered goal sedation) optimistically implies sedation communication occurred between PICU team on daily rounds. Quality of score does not capture scoring frequency nor the interventions. In the future, an order set will allow for more consistent documentation and data collection.
Description
Citation
Publisher
Creighton University
License
Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University