A Multisite Retrospective Study Evaluating the Implementation of the Pasero Opioid-Induced Sedation Scale (POSS) and Its Effect on Patient Safety Outcomes.

The Joint Commission recommended the Pasero Opioid-induced Sedation Scale (POSS) to minimize opioid-induced respiratory depression. However, there is a paucity of data describing its impact on patient safety. This study assessed the impact of POSS implementation or reeducation on naloxone use in patients receiving hydromorphone. This retrospective, Institutional Review Board-approved study performed with the Indianapolis Coalition for Patient Safety was conducted in two phases, 3 months before and after intervention. The intervention was POSS implementation or reeducation at six sites in a variety of practice settings. A total of 212 patients were evaluated. For the primary endpoint, naloxone use occurred in 1.9% of patients in each group and occurred in 3.1 versus 3.5 patients per 1,000 patient days pre- versus postintervention (p = .902). For secondary endpoints, POSS documentation increased post- versus preintervention, 78.1% versus 26.4% (p < .001). More patients experienced unintended sedation based on the Richmond Agitation and Sedation Scale or POSS post- versus preintervention, 12.2% versus 3.8% (p = .04). When the POSS was used, unintended sedation was likely detected before respiratory depression occurred and before naloxone was required. The lack of change in naloxone use and increased sedation postintervention may reflect that a POSS score 3 or 4 is a better marker of unintended sedation and should be considered as an endpoint instead of naloxone in future studies. The implementation or reeducation of the POSS at six area health-systems resulted in increased documentation of POSS and opioid-induced unintended sedation detection with no change in naloxone use.

An exploratory study of patient preferences for pain management during intravenous insertion: maybe we should sweat the small stuff.

The purpose of this exploratory study was to add to the body of knowledge about patient preferences for pain management during intravenous (IV) insertion. A convenience sample of 30 patients who were scheduled to undergo surgical or nonsurgical procedures requiring an IV catheter were given a choice among intradermal lidocaine, guided imagery, or no pain control strategy. Only four participants chose no pain management strategy, the traditional standard of care. Most (86.6%) desired a pain control strategy. Mean pain ratings on IV insertion were very low for all the three groups, although pain was significantly lower in the intradermal lidocaine group. This study illustrates that patients have preferences for pain control during IV insertion and believe that they should be involved in decisions about pain management.

Healing during existential moments: the "art" of nursing presence.

This article addresses nursing presence, a phenomenon essential to holistic nursing care. The concept is introduced and explained, supporting background information is reviewed, barriers are identified, and successful applications are illustrated in different clinical settings. Avowing that metaphysical knowledge is the underpinning to the art of nursing presence, a Transformative Nursing Presence Model is offered as a distinctive framework for nurses and organizations interested in fostering enhanced nursing presence.